PROBATE JDC CODE: WJC Original - Court Approved, SCAO 1st copy - Witness/Juror STATE OF MICHIGAN CASE NO. JUDICIAL DISTRICT JUDICIAL CIRCUIT WITNESS/JUROR CERTIFICATE COUNTY PROBATE ORI Court address Court telephone no.MI- The State of Michigan Defendants name, address, and telephone no. THE PEOPLE OF v CTN SID DOB Plaintiffs name Juvenile In the matter of Probate In the matter of TO: Disbursing authority of the city county township village Statute Ordinance Civil Juvenile Code WITNESS CERTIFICATE This certifies the following person was a witness in the above action and is entitled to the witness fee and mileage shown below: Name and address TO: Days served: $ Miles: $ Total fees and mileage:$ Approved Date Court clerk/Authorized official JUROR CERTIFICATE This certifies the following person was a juror in the above action and is entitled to the juror compensation shown below: TO: Name and address Days served: $ Miles: $ Total pay and mileage:$ Date Court clerk/Authorized official RECEIPT The above fee/compensation was received by me on . Date Signature MC 201 (4/89) WITNESS/JUROR CERTIFICATE