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MC 221

Statement of Service and Order for Payment of Court-Appointed Representative

Michigan · Michigan State Court Administrative Office · Effective January 1, 2021

This form is used to show that a court-appointed representative has provided services and to ask the court to pay that representative for their time and expenses. It includes a section for the representative to list the dates and types of services provided.

Open the official PDFfrom Michigan State Court Administrative Office

Where this fits in a case

Judgment

Stage: Judgment

This form is used in a case to formally notify the court and other parties that a court-appointed representative has finished their work and is requesting payment for their services.

Either party may file.

Common questions

Who fills out this form?
The form is for a court-appointed representative who has provided services for a defendant or respondent in a case.
What does the form ask the court to do?
It asks the court to order payment to the representative for all time and expenses related to the case.
Is there a filing fee mentioned?
The form does not mention a filing fee, but it does include a section for the court to issue a check for payment.

Revision history

No changes recorded since we started tracking this form on October 9, 2026. The current version took effect January 1, 2021.

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