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MC 283 (6/17) ORDER FOR DNA SAMPLE MCL 712A.18k, MCL 750.520m The State of Michigan THE PEOPLE OF v Defendant/Juvenile name, address, and telephone no. CTN SID DOB Juvenile in the matter of Approved, SCAO Original - Court 1st copy - Law enforcement agency/Sheriff2nd copy - Defendant/Juvenile3rd copy - Prosecuting attorney4th copy - Return STATE OF MICHIGAN JUDICIAL CIRCUIT COUNTY ORDER FOR DNA SAMPLE CASE NO. Court address Court telephone no. 1. On Date , the defendant/juvenile was arrested, convicted of, or found responsible for violation(s) or attempted violation(s) of , as prescribed in MCL 28.176, which require(s) that a DNA sample be taken. 2. The defendant/juvenile is incarcerated/detained at . is not incarcerated/detained. IT IS ORDERED: 3. The defendant/juvenile shall provide a DNA sample to the Name of investigating law enforcement agency/Sheriff to be forwarded to the Department of State Police in accordance with MCL 712A.18k, MCL 28.171 to MCL 28.176, MCL 750.520m, and Department of State Police Rules by Sentence date . 4. The investigating law enforcement agency/sheriff named above shall �le a return with the court that the sample was either taken or not required because a sample has already been taken. Date Judge Bar no. I certify and return that a DNA sample of the defendant/juvenile was taken and forwarded to the Department of State Police as ordered above. was not taken because the Department of State Police already has a DNA sample of the defendant/juvenile. Date Law enforcement agent/Sheriff CERTIFICATION AND RETURN