2nd copy - Complainant 3rd copy - Return Original - Court 1st copy - Owner of animal Approved, SCAO STATE OF MICHIGAN JUDICIAL DISTRICT CASE NO. COMPLAINT AND SUMMONS REGARDING DANGEROUS ANIMAL (GZ Case Type) Court telephone no. Court address IN THE MATTER OF , a dangerous animal COMPLAINT 1. I, , am interested in this matter as . 2. The animal named above is dangerous because the dog is over 6 months old, was without a license attached to its collar, and ran at large unaccompanied by its owner or engaged in lawful hunting after January 10 and before June 15 (MCL 287.286a). the dog destroyed property, or habitually caused damage by trespassing on property, of a person not the owner (MCL 287.286a). the dog attacked or bit a person (MCL 287.286a). the dog showed vicious habits or molested a person when that person was lawfully on the public highway (MCL 287.286a). the dog ran at large even though licensed and wearing the license tag (MCL 287.286a). the animal caused serious injury or death to a person or a dog (MCL 287.322). 3. Facts in support of the above claim(s) are: Attach separate document if needed. 4. I request a summons be issued commanding , Name (type or print) of , Address City State Zip the owner of the animal named above, to appear in court to show cause why the animal should not be destroyed. Complainant signature Complainant address City Subscribed and sworn to before me on My commission expires: State Zip , Date Signature: Date Telephone no. County, Michigan. Judge/Magistrate/Clerk/Notary Notary public, State of Michigan, County of SUMMONS If you require special accommodations to use the court because of a disability or if you require a foreign language interpreter to help you fully participate in court proceedings, please contact the court immediately to make arrangements. TO: IT IS ORDERED: 5. You are ordered to appear before this court on at Date Time at to show cause why the animal identified in the above complaint should not be destroyed. Failure to appear for this hearing may result in a bench warrant being issued for your arrest. 6. The owner shall immediately turn the animal over to to be held at the owner's expense until the hearing is held and a decision is made for the disposition of the animal pursuant to MCL 287.322. The owner shall notify this authority of the complaint and this order. Date issued Expiration date (not less than 2 days from hearing date) Judge/Magistrate Bar no. This summons is invalid unless served on or before its expiration date. This document must be sealed by the seal of the court. DC 118 (3/09) COMPLAINT AND SUMMONS REGARDING DANGEROUS ANIMAL MCL 287.286a, MCL 287.322 American LegalNet, Inc. www.FormsWorkFlow.com COMPLAINT AND SUMMONS REGARDING DANGEROUS ANIMAL Case No. PROOF OF SERVICE TO PROCESS SERVER: You must make and file your return with the court clerk no more than 6 days and no less than 2 days before the hearing date. If you are unable to complete service, you must return this original and all copies to the court clerk. CERTIFICATE / AFFIDAVIT OF SERVICE / NONSERVICE OR OFFICER CERTIFICATE I certify that I am a sheriff, deputy sheriff, bailiff, appointed court officer, or attorney for a party (MCR 2.104[A][2]), and that: (notarization not required) AFFIDAVIT OF PROCESS SERVER Being first duly sworn, I state that I am a legally competent adult who is not a party or an officer of a corporate party, and that: (notarization required) I served by registered or certified mail (copy of return receipt attached) a copy of the complaint and summons on: I personally served a copy of the complaint and summons on: Name(s) Complete address(es) of service Day, date, time I have personally attempted to serve the complaint and summons on the following person(s) and have been unable to complete service. Name(s) Complete address(es) of service Day, date, time I declare that the statements above are true to the best of my information, knowledge, and belief. Service fee $ Incorrect address fee Signature Miles traveled Fee $ Miles traveled Fee $ Name (type or print) TOTAL FEE $ $ Title Subscribed and sworn to before me on , County, Michigan. Date My commission expires: Signature: Date Deputy court clerk/Notary public Notary public, State of Michigan, County of ACKNOWLEDGMENT OF SERVICE I acknowledge that I have received service of this complaint and summons on on behalf of Day, date, time . Signature MCR 2.105 American LegalNet, Inc. www.FormsWorkFlow.com