Distribution: Original - Governor 1st copy - Court 2nd copy - Prosecutor Approved, SCAO STATE OF MICHIGAN JUDICIAL DISTRICT JUDICIAL CIRCUIT 3rd copy - Sheriff/DOC 4th copy - Defendant (Fugitive) 5th copy - Agent of demanding state CASE NO. WAIVER OF EXTRADITION Court address Court telephone no. Defendant (Fugitive) name, address, and telephone no. The State of Michigan THE PEOPLE OF v DLN DOB WAIVER I, , am the person wanted by Name County, on a pending arrest warrant charging the crime of State . I waive the issuance and service of a Michigan Governor's Warrant and all other procedures incidental to extradition proceedings, including the right to an attorney unless I have already retained one. I voluntarily return to the demanding state in the custody of the agent of that state. Date Signature CERTIFICATION BY JUDGE The defendant named above personally appeared before me on this date and was advised of his/her legal rights as provided by law. The defendant freely and voluntarily executed this waiver of extradition in my presence. The sheriff of Michigan Department of Corrections County, Michigan shall hold the defendant in custody without bail and shall deliver the defendant to the agents of . State Judge Date Bar no. This waiver must be sealed with the seal of the court. Send Governor's copy to: Governor's Office Attention: Extradition Officer Legal Division Olds Plaza 111 S. Capitol Lansing, Michigan 48933 MC 271 (3/09) WAIVER OF EXTRADITION MCL 780.25 American LegalNet, Inc. www.FormsWorkFlow.com