Original - Court 1st copy - Driver/Owner 2nd copy - Police officer 3rd copy - Storage custodian Approved, SCAO STATE OF MICHIGAN JUDICIAL DISTRICT JUDICIAL CIRCUIT CASE NO. ORDER FOR VEHICLE IMPOUNDMENT Court address Court telephone no. Defendant name, address, and telephone no. The State of Michigan THE PEOPLE OF v DLN DOB 1. Within 30 days after conviction for possessing or transporting liquor in a motor vehicle by a minor, a sworn complaint from a police officer requesting impoundment of the vehicle described below has been filed. (Impoundment for not less than 15 nor more than 30 days at a public/private garage is at owner's expense and risk.) 2. The defendant has been convicted of driving on a suspended/revoked or denied license. (Impoundment for not more than 120 days is with owner's implied consent, at owner's expense and risk.) 3. The described vehicle is alleged or found to be overweight. (Vehicle must be moved by and at expense and risk of owner/driver to a place of safekeeping until the load is made legal and: [a] fine and costs are paid, [b] a bond is posted, double the amount of fine and costs, or [c] the court is satisfied that the fine and costs will be paid.) ORDER Vehicle description: Year: Make: Model: Body style: Place of storage: Color: License plate number: Vehicle identification number: IT IS ORDERED: 4. Any police officer in the State of Michigan shall impound and deliver the described vehicle to the place of storage to be held for days unless otherwise ordered by the court. 5. The driver/owner shall move the described vehicle in compliance with item 3. Amount of fine and costs is $ . Amount of bond is $ . The described vehicle is ordered released upon compliance with item 3. Date MC 254 (3/09) Judge/Magistrate ORDER FOR VEHICLE IMPOUNDMENT Bar no. MCL 257.624b, MCL 257.724, MCL 257.904(1) American LegalNet, Inc. www.FormsWorkFlow.com