For use by Register of Deeds Original - Register of deeds 1st copy - Court 2nd copy - Judgment creditor Approved, SCAO STATE OF MICHIGAN JUDICIAL DISTRICT JUDICIAL CIRCUIT Court 3rd copy - Judgment debtor 4th copy - Return of service CASE NO. NOTICE OF JUDGMENT LIEN address Court telephone Plaintiff name v Judgment creditor's name and address no. Defendant name Judgment debtor's name and address Last 4 digits of social security no. or full tax identification no. Judgment creditor's attorney, bar no., address, and telephone no. Judgment debtor's attorney, bar no., address, and telephone no. 1. I am recording a judgment lien with the register of deeds in County against the judgment debtor's current or future interest in real property. 2. The current balance due on the judgment is $ . 3. The judgment was entered on and expires . 4. Except as otherwise prescribed by statute, this judgment lien expires 5 years after the date it is recorded with the register of deeds or when the underlying judgment expires, whichever is earlier. Date Signature of judgment creditor/judgment creditor's attorney This document must be sealed by the seal of the court. CERTIFICATION I certify that the above notice of judgment lien has been filed and includes the information required by MCL 600.2805(1). Clerk of the Court: Signed by: Date When recorded, return to MC 94 (3/06) NOTICE OF JUDGMENT LIEN Clerk/Deputy clerk . MCL 600.2805 American LegalNet, Inc. www.FormsWorkflow.com NOTICE OF JUDGMENT LIEN Case No. PROOF OF SERVICE TO PROCESS SERVER: File your return with the clerk of the court. If you are unable to complete personal service, you must file your return with the clerk of the court and return the judgment debtor's copy to the judgment creditor/attorney. CERTIFICATE / AFFIDAVIT OF SERVICE / NONSERVICE OR OFFICER CERTIFICATE I certify that I am a sheriff, deputy sheriff, bailiff, appointed court officer, or attorney for a party [MCR 2.104(A)(2)], and that: (notarization not required) AFFIDAVIT OF PROCESS SERVER Being first duly sworn, I state that I am a legally competent adult who is not a party or an officer of a corporate party, and that: (notarization required) I served a copy of the notice of judgment lien by certified mail on: I personally served a copy of the notice of judgment lien on (required when the judgment is $25,000 or more): Judgment debtor's name Complete address(es) of service Day, date, time I have personally attempted to serve the notice of judgment lien on the following person(s) and have been unable to complete service. Name(s) Service fee Complete address(es) of service Miles traveled $ Mileage fee $ Subscribed and sworn to before me on My commission expires: Signature Total fee $ Title , Date Date Day, date, time Signature: County, Michigan. Deputy court clerk/Notary public Notary public, State of Michigan, County of ACKNOWLEDGMENT OF SERVICE I acknowledge that I have received service of this notice of judgment lien on on behalf of Day, date, time . Signature MCR 2.105 American LegalNet, Inc. www.FormsWorkflow.com