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MC 82 (6/04) PAYMENT RECEIPT AND INVENTORY OF SEIZED PROPERTY
MCR 3.106
Original - Court
1st copy - Defendant
2nd copy - Officer
3rd copy - Plaintiff
Court address Court telephone no.
Approved, SCAO
STATE OF MICHIGAN CASE NO.
JUDICIAL DISTRICT
JUDICIAL CIRCUIT
PAYMENT RECEIPT AND
INVENTORY OF SEIZED PROPERTY
v
Defendant name(s)
Plaintiff name(s)
RECEIPT FOR PAYMENT OF FUNDS
1. I collected $ on from .
2. Payment was made by cash. check no. . money order/cashiers check no. .
3. a. Balance due ....................................................................................................... $
b. Minus payment................................................................................................... $
c. Statutory service and mileage fees .................................................................................................... $
d. Statutory percentage of line b. fees : 7% of _______ / 3% of _______ .......................................... $
e. Statutory expenses ............................................................................................................................ $
f. Plus total of lines c, d, and e. above ................................................................... $
g. New balance due* ............................................................................................ $
*Additional statutory interest, fees (7% of first $5,000.00 and 3% of remaining balance), and expenses may be charged in addition to the
unpaid balance.
INVENTORY OF PROPERTY SEIZED
Quantity Item/Description/Model Type/V.I.N./Serial Number
Real property seized (copy attached)
Property may be redeemed by payment in full of the judgment and all statutory fees and statutory expenses. If the property is not
redeemed, it will be sold at public sale and the proceeds applied to the judgment according to law. For further information call the
individual named below.
I certify that I am authorized to seize property under MCR 3.106 and that the above statements are true and accurate.
Date
Attach additional sheets if necessary
Date
Name (type or print) (Court Officer/Deputy Sheriff)
Signature
Telephone no.
TO THE OFFICER SEIZING PROPERTY: This form must be filed with the court within 7 days of the payment of funds or seizure
of property.
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