Free pc673.pmd - Michigan

Approved, SCAO

JIS CODE: PUF

STATE OF MICHIGAN PROBATE COURT COUNTY
CIRCUIT COURT - FAMILY DIVISION

FILE NO. PETITION AND ORDER TO USE FUNDS (CONSERVATORSHIP)

In the matter of PETITION 1. I,
Name

, am conservator of the estate.

2. The interested persons, addresses, and their representatives are identical to those appearing on the initial application/petition, except as follows: (for each person whose address changed, list the name and new address; attach separate sheet if necessary)

3. As of

Date

the ward's total assets are $ of the ward's money from

.
Account no. and name of financial institution

4. I REQUEST permission to withdraw $ to be used for the benefit of the ward as follows:

I declare under the penalties of perjury that this petition has been examined by me and that its contents are true to the best of my information, knowledge, and belief.
Date Attorney signature Name (type or print) Address City, state, zip Telephone no. Bar no. Petitioner signature Petitioner name (type or print) Address City, state, zip Telephone no.

ORDER IT IS ORDERED: 5. The petition is denied. 6. The petition is granted. The conservator is authorized to withdraw $ from the account stated in the petition. If access to these funds was restricted, access to the remainder of the funds is still restricted. Receipts or proof that the money was spent for the requested purpose shall be filed with this court by .
Date

7. Other:

Date

Judge

Bar no.

I certify that I have compared this copy with the original on file in this court and that it is a correct copy of the original.

Date

Deputy register

Do not write below this line - For court use only

PC 673 (9/07)

PETITION AND ORDER TO USE FUNDS (CONSERVATORSHIP)

MCL 700.5427