Approved, SCAO Original - Court Copies as needed STATE OF MICHIGAN JUDICIAL DISTRICT CASE NO. NOTICE OF SEIZURE AND INTENT TO FORFEIT AND DISPOSE OF PROPERTY Court telephone no. Court address The People of the State of Michigan The People of In the matter of v Defendant name, address, and telephone no. TO: *See other side for a list of people entitled to notice and proof of service. 1. BE ADVISED that the following real property, personal property, Description has been seized. 2. It is the intent of the a. seizing agency, Name and location , to forfeit and dispose of the personal property described above according to law. b. attorney general prosecuting attorney city/township attorney of to forfeit and dispose of the real property described above according to law. Date Signature of seizing agency or attorney Name (type or print) Title Address City, state, zip Telephone no. DC 43 (3/15) NOTICE OF SEIZURE AND INTENT TO FORFEIT AND DISPOSE OF PROPERTY MCL 600.4704 American LegalNet, Inc. www.FormsWorkFlow.com In the case of personal property, the seizing agency is responsible for serving this notice. In the case of real property, the attorney general, prosecuting attorney, or city/township attorney is responsible for serving this notice. This notice must be served within 28 days from the date of seizure or filing of lien notice. LIST OF PERSONS TO WHOM NOTICE MUST BE GIVEN 1. Each person charged (if charges are filed). 2. Each person with a known interest in the property. 3. Each mortgagee, person holding a security interest, and each lienholder. 4. Each holder of a preferred ship mortgage of record (if property is a watercraft more than 28 feet long or has a capacity of five tons or more). 5. Each person whose security interest is recorded with the appropriate public office under the Federal Aviation Act (if the property is an aircraft or part of an aircraft). 6. Each person with a known security interest in the property. 7. Each victim of the crime. 8. If personal property is seized, the seizing agency shall immediately notify the prosecuting attorney, or the attorney general, if the attorney general's office is actively handling the case. PROOF OF SERVICE I certify that on this date a copy of this notice was served on Name by personal service. certified mail. I declare that this proof of service is true to the best of my information, knowledge, and belief. Date Signature Name (type or print) NOTICE BY PUBLICATION It has been determined that the name and address of the person to whom this notice is directed cannot be reasonably ascertained or delivery of the notice cannot be reasonably accomplished. The notice on the other side was published for at least 10 consecutive publishing days as required by law in a newspaper of general circulation in the county where the property was seized or is located. Proof of publication is attached. Date Signature Name (type or print) American LegalNet, Inc. www.FormsWorkFlow.com