Approved, SCAO Original - Circuit court 1st copy - District court/agency 2nd copy - Appellee 3rd copy - Appellant STATE OF MICHIGAN JUDICIAL CIRCUIT COUNTY Court address CASE NO. ORDER ON APPLICATION FOR LEAVE TO APPEAL Court telephone no. Plaintiff's name, address, and telephone no. Appellant Appellee v Defendant's name, address, and telephone no. Appellant Appellee Plaintiff's attorney, bar no., address, and telephone no. Defendant's attorney, bar no., address, and telephone no. Date: IT IS ORDERED: 1. The appellant's application for leave to appeal is 2. Other: Judge: Bar no. granted. denied. Date Judge CERTIFICATE OF MAILING I certify that on this date I served a copy of this order on the parties or their attorneys and on the trial court or agency by first-class mail addressed to their last-known addresses as defined by MCR 2.107(C)(3). Date Court clerk CC 299 (3/13) ORDER ON APPLICATION FOR LEAVE TO APPEAL American LegalNet, Inc. www.FormsWorkFlow.com MCR 7.105(D)