The State of Michigan THE PEOPLE OF vProbationer name, address, and telephone no.CTN/TCNSIDDOBIn the matter of 1. þ Payment of restitution was ordered as a condition of probation for the individual named above. Upon review of the case as þ required under statute, I have determined that the probationer has not paid restitution as ordered. 2. þ The amount of the arrearage was $ as of Date . 3. þ The reasons for this arrearage are: Date þ Probation officer/Juvenile caseworker I certify that on this date copies of this report were served on the probationer and the prosecuting attorney by first-class mail addressed to their last-known addresses as defined by MCR 2.107(C)(3). Date þ Signature þ þ CERTIFICATE OF MAILING American LegalNet, Inc. www.FormsWorkFlow.com