Original - Court 1st copy - Defendant Approved, SCAO STATE OF MICHIGAN 2nd copy - Plaintiff 3rd copy - Return CASE NO. JUDICIAL DISTRICT JUDICIAL CIRCUIT COUNTY PROBATE SUMMONS AND COMPLAINT Court address Court telephone no. Plaintiff's name(s), address(es), and telephone no(s). Defendant's name(s), address(es), and telephone no(s). v Plaintiff's attorney, bar no., address, and telephone no. SUMMONS NOTICE TO THE DEFENDANT: In the name of the people of the State of Michigan you are notified: 1. You are being sued. 2. YOU HAVE 21 DAYS after receiving this summons to file a written answer with the court and serve a copy on the other party or take other lawful action with the court (28 days if you were served by mail or you were served outside this state). (MCR 2.111[C]) 3. If you do not answer or take other action within the time allowed, judgment may be entered against you for the relief demanded in the complaint. Issued This summons expires Court clerk *This summons is invalid unless served on or before its expiration date. This document must be sealed by the seal of the court. COMPLAINT Instruction: The following is information that is required to be in the caption of every complaint and is to be completed by the plaintiff. Actual allegations and the claim for relief must be stated on additional complaint pages and attached to this form. Family Division Cases There is no other pending or resolved action within the jurisdiction of the family division of circuit court involving the family or family members of the parties. An action within the jurisdiction of the family division of the circuit court involving the family or family members of the parties has been previously filed in Court. The action remains is no longer pending. The docket number and the judge assigned to the action are: Docket no. Judge Bar no. General Civil Cases There is no other pending or resolved civil action arising out of the same transaction or occurrence as alleged in the complaint. A civil action between these parties or other parties arising out of the transaction or occurrence alleged in the complaint has been previously filed in Court. The action remains is no longer pending. The docket number and the judge assigned to the action are: Docket no. Judge Bar no. VENUE Plaintiff(s) residence (include city, township, or village) Defendant(s) residence (include city, township, or village) Place where action arose or business conducted Date Signature of attorney/plaintiff If you require special accommodations to use the court because of a disability or if you require a foreign language interpreter to help you fully participate in court proceedings, please contact the court immediately to make arrangements. MC 01 (3/08) SUMMONS AND COMPLAINT MCR 2.102(B)(11), MCR 2.104, MCR 2.105, MCR 2.107, MCR 2.113(C)(2)(a), (b), MCR 3.206(A) American LegalNet, Inc. www.FormsWorkflow.com PROOF OF SERVICE SUMMONS AND COMPLAINT Case No. TO PROCESS SERVER: You are to serve the summons and complaint not later than 91 days from the date of filing or the date of expiration on the order for second summons. You must make and file your return with the court clerk. If you are unable to complete service you must return this original and all copies to the court clerk. 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 personally a copy of the summons and complaint, I served by registered or certified mail (copy of return receipt attached) a copy of the summons and complaint, together with List all documents served with the Summons and Complaint on the defendant(s): Defendant's name Complete address(es) of service Day, date, time I have personally attempted to serve the summons and complaint, together with any attachments, on the following defendant(s) and have been unable to complete service. Defendant's name Complete address(es) of service Day, date, time I declare that the statements above are true to the best of my information, knowledge, and belief. Service fee Miles traveled $ Mileage fee $ Signature Total fee $ Name (type or print) Title Subscribed and sworn to before me on , County, Michigan. Date My commission expires: Signature: Date Deputy court clerk/Notary public Notary public, State of Michigan, County of ACKNOWLEDGMENT OF SERVICE I acknowledge that I have received service of the summons and complaint, together with Attachments on Day, date, time on behalf of . Signature American LegalNet, Inc. www.FormsWorkflow.com