Form Dc 102a - Complaint Case No. Non-Payment Of Rent - Landlord - Tenant Page 2
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Original - Court
1st copy - Tenant
2nd copy - Mailing
3rd copy - Landlord
Approved, SCAO
STATE OF MICHIGAN
CASE NO.
COMPLAINT
JUDICIAL DISTRICT
NON-PAYMENT OF RENT
Landlord - Tenant
Court address
Court telephone no.
Plaintiff name(s), address(es), and telephone no.(s)
Defendant name(s) and address(es)
v
Plaintiff's attorney, bar no., address, and telephone no.
The plaintiff states:
1. Attached to this complaint is a copy of the lease or occupancy agreement, if any, under which possession is claimed, and a
copy of the notice to quit or demand for possession showing when and how it was served.
2. The owner of the property described in the attached demand for possession is:
Name (type or print)
3. The defendant is in possession of the following portion of the property:
4. The plaintiff has a right to possession of the property for non payment of rent:
a. Rental rate: $
per
b. Payable on:
Day or date
c. Rent is paid through
d. Total rent due now is $
Date
e. Other money is due: $
for
and due by
5. (If applicable) The tenancy involves housing operated by or under rules of a governmental unit. The rule or law under
which the tenancy is ended is
.
6. (Must be checked unless modified by lease) Plaintiff declares that this residential property was kept fit for the use intended,
and has been kept in reasonable repair during the term of the lease.
7. The defendant has not complied with the demands made.
8. The plaintiff asks for a judgment of possession and costs and asks the court to issue an order to evict the occupants.
9. A jury trial is demanded.
10. There is no other pending or resolved civil action arising out of the same transaction or occurrence alleged in this complaint.
11. A civil action between these parties or other parties arising out of the transaction or occurrence alleged in this complaint
has been previously filed in
Court. The docket number and assigned judge are:
The action
remains
is no longer
pending.
SUPPLEMENTAL COMPLAINT
12. (If applicable) Complaint is made and judgment is sought for money damages against the defendant as follows:
Rent owing as set out in paragraph 4 above, plus additional rent at the rate of $
per
until judgment, plus costs.
Damages claimed:
I declare that the statements above are true to the best of my information, knowledge, and belief.
Date
Plaintiff/Attorney signature
COMPLAINT, NON-PAYMENT OF RENT, Landlord - Tenant
DC 102a (6/97)
MCR 2.113(C), MCR 4.201(B)
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