Original - Court 1st copy - Defendant/Juvenile 2nd copy - Surety or other depositor JIS CODE: OFB Approved, SCAO STATE OF MICHIGAN JUDICIAL DISTRICT JUDICIAL CIRCUIT ORI CASE NO. ORDER REVOKING RELEASE AND FORFEITING BOND, NOTICE OF INTENT TO ENTER JUDGMENT Court address Court telephone no. MIAgency Report No. THE PEOPLE OF Defendant's name The State of Michigan v CTN Juvenile SID DOB In the matter of TO: (Name and address of defendant or parent posting bond.) (Name and address of surety or other depositor posting bond.) *Use Note: Surety appearance is required only when the revocation order is for failure to appear. ORDER The defendant/juvenile has violated the conditions of bail as described below: Offense(s) Violation(s) nonappearance on Full bail amount other: Amount of cash deposited TYPE OF BOND: 10% cash Personal recognizance $ $ Cash Surety Real property IT IS ORDERED the release is revoked and bond is forfeited. The proceeds of a bond, whether cash, surety, or designated real property, shall be disposed of within 45 days of the date of this order. *The surety shall appear before the court to show cause why judgment should not enter against the surety for the full amount of the surety bond, Date and time . Date Judge Bar no. NOTICE TO THE DEFENDANT/PARENT AND JUVENILE: You have 28 days from the date of this order to surrender yourself to the court or to satisfy the court that there was compliance with the conditions of release or that compliance was impossible through no fault of the defendant/juvenile. Otherwise, judgment for the full bail amount plus costs will be entered against you. Money or other security on deposit will be used toward payment of the judgment. A warrant for your arrest/order to apprehend has been will be issued. CERTIFICATE OF MAILING I certify that on this date I served a copy of this order and notice on the defendant or parent and surety or person who posted bond by first-class mail addressed to their last-known addresses as defined in MCR 2.107(C)(3). Date MC 218 (3/08) Clerk/Deputy MCL 765.15, MCL 780.66, MCL 780.67, MCR 3.935(F)(5), MCR 6.106(I) ORDER REVOKING RELEASE AND FORFEITING BOND, NOTICE OF INTENT TO ENTER JUDGMENT American LegalNet, Inc. www.FormsWorkflow.com