Approved, SCAO Original - Court 1st copy - Judge/Assignment clerk (green) 2nd copy - Respondent (blue) 3rd copy - Petitioner (pink) 4th copy - Return (yellow) STATE OF MICHIGAN JUDICIAL CIRCUIT COUNTY Court address MOTION TO MODIFY, EXTEND, OR TERMINATE PERSONAL PROTECTION ORDER A CASE NO. Court telephone no. B Petitioner's name Address and telephone no. where court can reach petitioner Age Respondent's name, address, and telephone no. Age v MOTION C D 1. On 2. Date a personal protection order was entered by this court. terminate the order. a. I am the respondent. I ask the court to conduct a hearing to modify b. I am the petitioner. I ask the court to conduct a hearing to modify the order. c. I am the petitioner. I ask the court to extend terminate the order. Explain why you want the order modified, extended, or terminated. If box a. is checked, the respondent must show good cause if the order was issued after a full hearing or if more than 14 days have passed since the order was issued ex parte (without a hearing). E 3. I have a next friend motioning for me. I certify that the next friend is not disqualified by statute and is an adult. F Date Signature of moving party Complete this Notice of Hearing only if you checked box 2.a. or 2.b. above. NOTICE OF HEARING G You are notified that a hearing has been scheduled to modify, extend, or terminate the personal protection order issued in this case. Judge: Date: Time: Location: 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. The court can modify, extend, or terminate the order even if you do not attend the hearing. It is important for you to attend. H Date Signature of moving party MCL 600.2950, MCL 600.2950a, MCR 3.707 CC 379 (3/12) MOTION TO MODIFY, EXTEND, OR TERMINATE PERSONAL PROTECTION ORDER American LegalNet, Inc. www.FormsWorkFlow.com PROOF OF SERVICE Motion to Modify/Extend/Terminate Personal Protection Order Case No. TO PROCESS SERVER: You must serve the copies of the motion to modify, extend, or terminate personal protection order and file proof of service with the court clerk. 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 a copy of the motion to modify, extend, or terminate personal protection order by: personal service registered mail, delivery restricted to the nonmoving party (return receipt attached) on: Nonmoving party name Complete address of service Day, date, time I have personally attempted to serve a copy of the motion to modify, extend, or terminate personal protection order on the following party and have been unable to complete service. Nonmoving party name Complete address of service I declare that the statements above are true to the best of my information, knowledge, and belief. Service fee Miles traveled Fee Signature Name (type or print) Incorrect address fee Miles traveled Fee TOTAL FEE $ $ $ $ $ Title Subscribed and sworn to before me on My commission expires: Date Date , Signature: Deputy court clerk/Notary public County, Michigan. Notary public, State of Michigan, County of ACKNOWLEDGMENT OF SERVICE I acknowledge that I have received a copy of the motion to modify, extend, or terminate personal protection order on . Day, date, time Signature of nonmoving party MCR 2.105(A)(2) American LegalNet, Inc. www.FormsWorkFlow.com Form CC 379 MOTION TO MODIFY, EXTEND, OR TERMINATE PERSONAL PROTECTION ORDER Use this form if you want the court to modify, extend, or terminate the personal protection order. American LegalNet, Inc. www.FormsWorkFlow.com INSTRUCTIONS FOR COMPLETING "MOTION TO MODIFY, EXTEND, OR TERMINATE PERSONAL PROTECTION ORDER" Please print neatly. Press firmly because you are printing on five copies. By filling in this form, you are asking the court to modify, extend, or terminate a personal protection order. Items A through E must be completed before your motion can be filed with the court. Please read the instruction for each item. Then fill in the correct information for that item on the form. A B Fill in the "Case No." the same way it appears on form CC 376 or CC 380. Fill in the "petitioner" and "respondent" and addresses the same way they appear on form CC 376 or CC 380. including the ages of the "petitioner" and "respondent" if either of you are under the age of 18. Write in the same date that form CC 376 or CC 380 was signed by the judge. That date is in the lower left hand corner of form CC 376 or CC 380. If you are the person the protection order is against, check item 2.a. Also check either the box "modify" if you want the court to change something in the order or check the box "terminate" if you want the court to terminate the entire order. Then explain why you want the order changed or terminated. If the order was issued without a hearing (ex parte), you may file a motion and request a hearing within 14 days after being served with, or receiving actual notice of, the order. If the order was issued ex parte and more than 14 days have passed, you must show good cause for the motion. If the order was issued after a full hearing, you must show good cause for the motion. See MCR 3.707(A)(1)(b). If you are the person who is protected by the order, you can check either item 2.b. or item 2.c. Check item 2.b. if you want the court to change something in the order. Check item 2.c. if you want the court to extend the expiration date of the order or terminate the entire order. Then explain why you want the order extended or terminated. To extend the expiration date of the order, you must file this motion no later than 3 days before the order expires. E If you are under 18 years old, you may need an adult (called a "next friend") to petition for you. Check this box if you have a next friend helping you file this form. Write in today's date and sign the form. If you checked box 2.a. or box 2.b. in D you must get a hearing date.