Original - Court 1st copy - Plaintiff 2nd copy - Defendant 3rd copy - SCAO Approved, SCAO STATE OF MICHIGAN JUDICIAL CIRCUIT COUNTY CASE NO. DISMISSAL OF PRISONER CIVIL ACTION, Frivolous Action Court address Court telephone no. Plaintiff's name and address Defendant's name and address v Prisoner number Plaintiff's attorney, bar no., address, and telephone no. Defendant's attorney, bar no., address, and telephone no. THE COURT FINDS: 1. The plaintiff filed a complaint on concerning prison conditions. Date 2. The plaintiff was determined indigent and unable to pay the filing fee and costs required by law. The full filing fee of $ was waived. The partial filing fee of $ was waived. An attorney was appointed. 3. The plaintiff was determined indigent and shall pay the filing fee and costs as required by MCL 600.2963. 4. Total unpaid fees and costs to date are $ . 5. The complaint or a portion of the complaint is frivolous as follows: IT IS ORDERED: 6. The civil action is dismissed with prejudice as a frivolous action, and the following unpaid fees and costs shall be paid by the plaintiff in accordance with this order. Filing Fee Other Costs (specify) Attorney Fees Total $ $ $ $ Payments toward the unpaid fees and costs shall be as follows: 7. The good time/disciplinary credits accumulated by the plaintiff as of the following amount. All. All up to days. Date shall be forfeited in Date Bar no. Judge A copy of this order shall be promptly mailed to the State Court Administrative Office. CC 78 (3/08) DISMISSAL OF PRISONER CIVIL ACTION, Frivolous Action MCL 600.5501 et seq., MCL 800.33 et seq. American LegalNet, Inc. www.FormsWorkflow.com