Approved, SCAO STATE OF MICHIGAN 6th JUDICIAL CIRCUIT OAKLAND COUNTY Original – Court 1st copy – Judge/Assignment clerk (green) 2nd copy – Respondent (blue) 3rd copy – Petitioner (pink) 4th copy – Return (yellow) MOTION TO MODIFY, EXTEND, OR TERMINATE PERSONAL PROTECTION ORDER CASE NO. Court address 1200 N. Telegraph Road, Pontiac, MI 48341-1043 Court telephone no. (248) 858-0581 Age Petitioner name Address and telephone no. where court can reach petitioner Respondent name, address, and telephone no. Age v MOTION 1. On a personal protection order was entered by this court. Date 2. a. I am the respondent. I ask the court to conduct a hearing to modify terminate b. I am the petitioner. I ask the court to conduct a hearing to modify the order because: c. I am the petitioner. I ask the court to extend terminate the order because: the order because: Explain why you want the order modified, extended, or terminated. 3. I have a next friend motioning for me. I certify that the next friend is not disqualified by statute and is an adult. Date Signature of moving party Complete this Notice of Hearing only If you checked box 2.a. or 2.b. above. NOTICE OF HEARING You are notified that a hearing has been scheduled to modify, extend, or terminate the personal protection order issued in this case. Judge: Date: Time: Location: If you require special accommodations to use the court because of disabilities, please contact the court immediately to make arrangements. The court can modify, extend, or terminate the order even if you do not attend the hearing. It is important for you to attend. Date Signature of moving party FOR COURT USE ONLY The motion to terminate by the petitioner is granted without hearing. A Removal of Entry from LEIN (Form MC 239) shall be issued. Date Judge MCL 600.2950, MCL 600.2950a, MCR 3.707 CC 379 (3/09) MOTION TO MODIFY, EXTEND, OR TERMINATE PERSONAL PROTECTION ORDER American LegalNet, Inc. www.FormsWorkFlow.com