MCF No. 3.16, 3.

18
Notice of Death/Incapacity
of Representative

Original – Court, 1st Copy – Plaintiff, 2nd Copy – Defendant, Other copies as needed
Enter information in block letters in all parts of the Form except when reserved for Court
use, which shall be completed by the Clerk.
For Court Use Only
(Judicial Region)

(Municipality/City/Province)

 METC/MTCC/MTC/MCTC
 RTC

BRANCH
Case No.
Plaintiff/
Petitioner , v.
Defendant/
Respondent

COUNSEL OR PARTY WITHOUT COUNSEL

Nam
e
Firm Name
Address
Email Address
Tel./Cel./Fax Nos.
PTR No. Date/
Roll No. Place of Issue
 Lifetime
IBP No.  Date/Chapter
 Compliance
MCL  Exemption No
E .
Other Compliances
Counsel for
 Plaintiff/
Petitioner
 Defendant/
Respondent
 Other

NOTICE OF DEATH/INCAPACITY OF
REPRESENTATIVE
UNDER RULES 3.16 and 3.18

______________________________
(name)
gives notice that:

1. After the filing of the action, ___________________________:

(name of original representative)

 died, as evidenced by the death certificate attached as an

annex.
 was incapacitated, as evidenced by the medical certificate
attached as an annex.

page 1 of 2
 2. This action shall continue to be  prosecuted or  defended
by:

 _______________________________ as evidenced by
(name of new representative)
_______________________.
 personally by the party.

3. The new representative may be served with court notices, other

processes, and pleadings at _______________________________.
(address)

PROOF OF SERVICE
A copy of this Motion was served upon:
Party/Counsel’s Name Method Place Served Date Served
Personal Service
Licensed Courier
Registered Mail
Facsimile or Other
Electronic Means
Personal Service
Licensed Courier
Registered Mail
Facsimile or Other
Electronic Means
Personal Service
Licensed Courier
Registered Mail
Facsimile or Other
Electronic Means
Personal Service
Licensed Courier
Registered Mail
Facsimile or Other
Electronic Means
Proof of such service is attached to this Motion as an Annex.

Date Party/Party’s Counsel Name and Signature

ORDER

The ☐ death ☐ incapacity of ____________________ is noted.

(name)

 Let copies of all documents, pleadings, and court processes be furnished to the
new representative _________________ at the given address.
(name)

Judge Date

SPECIAL INSTRUCTIONS

COPIES TO BE FILED WITH THE COURT

An original of this Form must be filed with the Court together with such additional copies
equivalent to the number of parties in the case, to be used by the Court in sending out its
court order contained in the same Form.

NOTICE OF DEATH/INCAPACITY OF REPRESENTATIVES page 2 of 2