CID-012 (11/2018) MICHIGAN STATE POLICE

NOTICE OF SEIZURE AND INTENTION TO FORFEIT Seizing Law Enforcement Agency Phone Number

- Location to File Claim Address

Address Where Seized: Number and Street City State Zip Code

Description of Property - Describe Fully

(Manufacturer/Make/Serial No. - Denomination/Amount of Money)

CHECK ONE - Property seized is subject to forfeiture pursuant to the: CONTROLLED

SUBSTANCES ARTICLE OF THE PUBLIC HEALTH CODE Since the total value of the seized property does not exceed $50,000, it is the intent of the seizing agency to forfeit and dispose of the above described property according to the provision of MCL 333.7521, et seq. If you or any person claiming an interest in the above

described property wish to challenge the seizure and forfeiture of the property or wish to claim an interest in the property, you must file a written claim with the seizing agency at the above address within 20 days after receipt of this notice (or the date of the first publication of this notice in the newspaper). Upon receipt of a written claim, a court action will be filed to decide the issue of forfeiture in accordance with MCL 333.7523. Failure to file a claim of interest within the 20 days shall cause the listed property to be declared forfeited and disposed of according to law.

STOLEN, EMBEZZELED, OR CONVERTED PROPERTY CHAPTER OF THE PENAL CODE (CHOP SHOP) If you or any person claiming an interest in the above described property wish to challenge the seizure and forfeiture of the property or

wish to claim an interest in the property, you must file a written claim with the prosecutor's office after receipt of this notice.

GAMBLING CHAPTER OF THE PENAL CODE OR GAMING CONTROL AND REVENUE ACT If you or any person claiming an interest in the above described property wish to challenge the seizure and forfeiture of the property or

wish to claim an interest in the property, you must file a written claim with the prosecutor's office after receipt of this notice.

REVISED JUDICATURE ACT OF 1961 ("OMNIBUS") If you or any person claiming an interest in the above described property wish to challenge the seizure and forfeiture of the property or

wish to claim an interest in the property, you must file a written claim with the prosecutor's office after receipt of this notice.

PROOF OF SERVICE

I served a copy of the Notice of Seizure and Intention to Forfeit and Dispose of Property as follows:

Person Served Date Served How Notice Served Certified Mail

In Person Publication

Address: Number and Street City State Zip Code

Signature of Server Date Signed Reviewed By

DISTRIBUTION:

Original - Owner or Interested Parties

Claim Deadline Date Seized

Incident No. AUTHORITY: MCL 333.7523 COMPLIANCE: Required PENALTY: Return of property to owner

Value of Property