Motion To Modify, Extend Or Terminate Order Page 2

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Motion to Modify/Extend/Terminate
Personal Protection Order
PROOF OF SERVICE
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
AFFIDAVIT OF PROCESS SERVER
I certify that I am a sheriff, deputy sheriff, bailiff, appointed
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
court officer, or attorney for a party [MCR 2.104(A)(2)], and
that:
that:
(notarization not required)
(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
,
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 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)

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