Approved, SCAO STATE OF MICHIGAN CASE NO. JUDICIAL DISTRICT REMITTAL OF DISQUALIFICATION JUDICIAL CIRCUIT COUNTY PROBATE Court address Court telephone no.Plaintiff name(s) and address(es) Defendant name(s) and address(es) v Plaintiffs attorney, bar no., address, and telephone no. Defendants attorney, bar no., address, and telephone no.1. Judge is willing to Bar no. participate in the proceedings regarding this matter and has requested that the parties consider waiving disqualification under MCR 2.003(D). The judge has no personal bias or prejudice concerning a party in the matter. 2. The possible grounds for disqualification are: 3. The parties, without participation by the judge, all agree that the judge should not be disqualified. Date Judge Date Plaintiff signature/Attorney for plaintiff Bar no.Date Plaintiff signature/Attorney for plaintiff Bar no.Date Defendant signature/Attorney for defendant Bar no.Date Defendant signature/Attorney for defendant Bar no. MCR 2.003(D)MC 272 (9/00) REMITTAL OF DISQUALIFICATION