Approved, SCAO JIS CODE: OTJ STATE OF MICHIGAN JUDICIAL CIRCUIT - FAMILY DIVISION COUNTY Court address REQUEST AND ORDER TO TERMINATE COURT JURISDICTION CASE NO. PETITION NO. Court telephone no. 1. In the matter of name(s), alias(es), DOB REQUEST TO TERMINATE COURT JURISDICTION 2. I, Name , Title , request that the jurisdiction of this court be terminated with without a hearing, for the following reason a. the terms of probation have been completed. b. the minor has attained the maximum jurisdictional age. c. the minor is in the full care, custody, and control of the parent(s), guardian, or legal custodian, and further court supervision is unnecessary. d. other: 3. Money is owed to the court as follows: I declare that this request has been examined by me and that its contents are true to the best of my information, knowledge, and belief. Address City, state, and zip Telephone no. Signature Name (type or print) Date RECOMMENDATION REGARDING REQUEST TO TERMINATE COURT JURISDICTION 4. IT IS RECOMMENDED that this request be a. granted because b. denied without instruction because c. denied with the following instruction because d. set for hearing on at Date at before Hon. . Referee Bar no. ORDER REGARDING REQUEST TO TERMINATE COURTJURISDICTION 5. IT IS ORDERED that this request is a. granted and the jurisdiction of this court is terminated except that the court reserves the right to enforce payments of any delinquent account or unpaid reimbursement order unpaid as of the date of this order because Any wage assignment presently in effect shall remain in effect until the sums owed by the employee are paid in full. b. denied without instruction because c. denied with the following instruction because Date Judge Bar no. MCL 712A.18(2), MCL 712A.18c(4), MCL 712A.19(1) American LegalNet, Inc. www.FormsWorkflow.com JC 36 (9/06) REQUEST AND ORDER TO TERMINATE COURT JURISDICTION