1st copy – Plaintiff, Part 1 / 4th copy – Licensing agency, Part 2
Approved, SCAO / 2nd copy – Defendant, Part 1 / 5th copy – Return of service
STATE OF MICHIGAN
/ORDER SUSPENDING LICENSE
/ CASE NO.JUDICIAL CIRCUIT
COUNTY
COURT CODE
Court address / Court telephone no.Plaintiff’s name, address, and telephone no. / licensee / Defendant’s name, address, and telephone no. / licensee
v
Attorney: / Attorney:
THE COURT FINDS:
1. The licensee
a. / failed to respond to a notice of proposed license suspension in a timely manner and also failed to pay the entire arrearage.
b. / requested a hearing based on a notice of proposed license suspension but failed to appear at the scheduled hearing and
failed to pay the entire arrearage.
c. / failed to comply with an order for payment of arrearage.
d. / failed to comply with an order for payment of arrearage following a contempt finding at a show-cause hearing.
e. / failed to comply with a makeup and ongoing parenting-time schedule.
f. / failed to appear at a show-cause hearing.
IT IS ORDERED:
2. / Within 7 business days after receiving this order, the licensing agency shall suspend and not issue to the licensee named above
an occupational license / a recreational license / a sporting license
until further order of the court.
3. / After receiving notice under MCL 257.321c, the Secretary of State shall immediately suspend the driver’s/chauffeur’s license.
Date / Judge / Bar no.
CERTIFICATE OF MAILING
I certify that on this date I served a copy of this order on the parties or their attorneys and the licensing agency(ies) by first-class mail
addressed to their last-known addresses as defined in MCR 3.203.
Date / Signature
PART 1
MCL 552.602(h), MCL 552.629(4), MCL 552.630,
FOC 84 (3/15) ORDER SUSPENDING LICENSE / MCL 631(1)(c), MCL 552.633(2), MCL 552.645(1)
Original – Court, Part 1 / 3rd copy – Friend of the court, Part 2
1st copy – Plaintiff, Part 1 / 4th copy – Licensing agency, Part 2
Approved, SCAO / 2nd copy – Defendant, Part 1 / 5th copy – Return of service
STATE OF MICHIGAN
/ORDER SUSPENDING LICENSE
/ CASE NO.JUDICIAL CIRCUIT
COUNTY
COURT CODE
Court address / Court telephone no.Plaintiff’s name, address, and telephone no. / licensee / Defendant’s name, address, and telephone no. / licensee
v
Attorney: / Attorney:
Date of birth / This information may be confidential andshould only be
distributed to the friend of the court andlicensing agency.
Driver's license no.
Occupational license no.
Known professional licenses
THE COURT FINDS:
1. The licensee
a. / failed to respond to a notice of proposed license suspension in a timely manner and also failed to pay the entire arrearage.
b. / requested a hearing based on a notice of proposed license suspension but failed to appear at the scheduled hearing and
failed to pay the entire arrearage.
c. / failed to comply with an order for payment of arrearage.
d. / failed to comply with an order for payment of arrearage following a contempt finding at a show-cause hearing.
e. / failed to comply with a makeup and ongoing parenting-time schedule.
f. / failed to appear at a show-cause hearing.
IT IS ORDERED:
2. / Within 7 business days after receiving this order, the licensing agency shall suspend and not issue to the licenseenamed above
an occupational license / a recreational license / a sporting license
Error! Reference source not found.
until further order of the court.
3. / After receiving notice under MCL 257.321c, the Secretary of State shall immediately suspend the driver’s/chauffeur’s license.
Date / Judge / Bar no.
CERTIFICATE OF MAILING
I certify that on this date I served a copy of this order on the parties or their attorneys and the licensing agency(ies) by first-class mail
addressed to their last-known addresses as defined in MCR 3.203.
Date / Signature
PART 2
MCL 552.602(h), MCL 552.629(4), MCL 552.630,
FOC 84 (3/15) ORDER SUSPENDING LICENSE / MCL 552.631(1)(c), MCL 552.633(2), MCL 552.645(1)