Approved, SCAO Original - Court 1st copy - Plaintiff/Attorney 2nd copy - Defendant/Attorney 3rd copy - Extra STATE OF MICHIGAN JUDICIAL DISTRICT APPLICATION AND EX PARTE ORDER TO FILE LIEN ON REAL PROPERTY SUBJECT TO FORFEITURE CASE NO. Court address Court telephone no. The People of the State of Michigan The People of In the matter of v Defendant name, address, and telephone no. APPLICATION AND AFFIDAVIT 1. I am the attorney general prosecuting attorney city/township attorney for Description and I state: there is probable cause to believe the following real property, , is subject to forfeiture based upon the following reasons: . 2. I REQUEST an order authorizing the filing of a lien notice because it is believed a. the property is the proceeds of a crime. b. the property is the substituted proceeds of a crime. c. the property is the instrumentality of a crime. Date Signature Name (type or print) Subscribed and sworn to before me on My commission expires: Date , Signature: Notary public County, Michigan. Notary public, State of Michigan, County of ORDER 3. THE COURT FINDS there is is not probable cause to believe the real property described above is the proceeds of a crime, the substituted proceeds of a crime, or the instrumentality of a crime and is subject to forfeiture. IT IS ORDERED: 4. A lien notice may be filed against the real property. 5. The application is denied. Date Judge Bar no. MCL 600.4703(3) DC 42 (3/15) APPLICATION AND EX PARTE ORDER TO FILE LIEN ON REAL PROPERTY SUBJECT TO FORFEITURE American LegalNet, Inc. www.FormsWorkFlow.com