What is the Claim of Appeal or Request to Withdraw Admission form?

It is a court form for a plaintiff to claim an appeal from a civil infraction judgment or for a defendant to request withdrawal of an admission.

Who can use this civil infraction form?

A plaintiff claiming an appeal or a defendant asking to withdraw an admission can use the form. It includes fields for case and judgment information and signatures.

Do I need a notary for this civil infraction form?

No. The form has signature and date fields but no notary block or notarized attachment requirement; the signer just signs and dates it.

How do I submit this form?

The form lists spaces for the court address and telephone number but provides no filing instructions. Submit it to the court identified on the form and check the county website for current contact details.

Jackson County, MI · Jackson County

No notary required

Claim of Appeal of Right/Request to Withdraw Admission and Order, Civil Infraction

This form lets a plaintiff claim an appeal or lets a defendant request to withdraw an admission in a civil infraction case.

At a glance

Issued by: City of Jackson County · Jackson County, Jackson County, Michigan
Notarization: Not required: file this form without a notary.
Official source: mijackson.org
Blank form: Download the PDF
Catalogued: Oct 5, 2026
Machine-readable: JSON record · about the forms index

$First page of the Claim of Appeal of Right/Request to Withdraw Admission and Order, Civil Infraction$

What this form is

Use this form to claim an appeal from a civil infraction judgment or request to withdraw an admission. It includes fields for the case number, infraction date, judgment details, signatures, and an order granting or denying a withdrawal request. The form also records appeal security, bond, and any fine and costs paid.

Who needs it

A plaintiff claiming an appeal or a defendant requesting to withdraw an admission in a civil infraction case may use this form.

How to submit it

The form provides spaces for the court address and telephone number but does not give filing instructions. Submit it to the court identified on the form; check the county website for current contact details.

About notarization

This form is signed without a notary; the plaintiff or defendant signs and dates it, and no notarized or sworn attachment is mentioned.

How to submit this form

1
Download the Form
Download the civil infraction appeal and request form.
2
Complete the Form
Enter the case and infraction details, select the applicable appeal or withdrawal request, and complete the relevant signature and date fields.
3
Review Attachments
The form does not mention any required attachment.
4
Submit to the Court
Submit the form to the court identified on it; check the county website for current contact details.

Frequently asked questions

What is the Claim of Appeal or Request to Withdraw Admission form?: It is a court form for a plaintiff to claim an appeal from a civil infraction judgment or for a defendant to request withdrawal of an admission.
Who can use this civil infraction form?: A plaintiff claiming an appeal or a defendant asking to withdraw an admission can use the form. It includes fields for case and judgment information and signatures.
Do I need a notary for this civil infraction form?: No. The form has signature and date fields but no notary block or notarized attachment requirement; the signer just signs and dates it.
How do I submit this form?: The form lists spaces for the court address and telephone number but provides no filing instructions. Submit it to the court identified on the form and check the county website for current contact details.

Need something notarized?

This Claim of Appeal of Right/Request to Withdraw Admission and Order, Civil Infraction doesn’t need a notary, but Michigan residents can notarize other documents online with a commissioned online notary.