STATE OF MICHIGAN THIRD JUDICIAL CIRCUIT WAYNE COUNTY CASE NO.: _________________ MOTION JUDGE ____________________ For: COURT ADDRESS: TWO WOODWARD AVENUE, DETROIT, MI 48226 Plaintiff’s name, address and telephone No. Defendant’s name, address and telephone no. VS MOTION PETITIONER is: (check one) DEFENDANT PLAINTIFF COURT-ORDERED CUSTODIAN (if different) 1. I request that the court order the following: (Write a detailed explanation. Use additional sheet if necessary) 2. This is requested and should be ordered because: (Write a detailed explanation. Use additional sheet if necessary). Date:___________________________ _________________________________________ Signature of Party Filing Motion A hearing on this motion will be held as follows: Date:______________________________ Before Referee ________________________________ Time: _____________________________ Location:__________________ 645 Penobscot Building, Detroit, MI 48226 DO NOT WRITE BELOW THIS LINE * PROOF OF SERVICE * FOR FRIEND OF THE COURT USE ONLY I certify I mailed a copy of this Motion and Hearing Notice to the parties at their Friend of the Court addresses of record on this date. Date:__________________________ Signature:____________________________________ FD/FOC4025 (10/04) MOTION FOR HEARING BEFORE ASSIGNED REFEREE American LegalNet, Inc. www.FormsWorkflow.com