Free mc258.pmd - Michigan

Approved, SCAO

Original - Court 1st copy - Probationer 2nd copy - Probation officer 3rd copy - Prosecuting attorney

STATE OF MICHIGAN JUDICIAL DISTRICT JUDICIAL CIRCUIT COUNTY
Court address

CASE NO. REPORT OF NONPAYMENT OF RESTITUTION
Court telephone no.

The State of Michigan THE PEOPLE OF v

Probationer name, address, and telephone no.

CTN/TCN

SID

DOB

In the matter of

1. Payment of restitution was ordered as a condition of probation for the individual named above. Upon review of the case as required under statute, I have determined that the probationer has not paid restitution as ordered. 2. The amount of the arrearage was $ 3. The reasons for this arrearage are: as of
Date

.

Date

Probation officer/Juvenile caseworker

CERTIFICATE OF MAILING I certify that on this date copies of this report were served on the probationer and the prosecuting attorney by first-class mail addressed to their last-known addresses as defined by MCR 2.107(C)(3).
Date Signature

MC 258 (6/09)

REPORT OF NONPAYMENT OF RESTITUTION

MCL 712A.30(18), MCL 769.1a(18), MCL 780.766(15), MCL 780.794(18), MCL 780.826(15)