Free pc651.p65 - Michigan

Approved, SCAO

JIS CODE: FGM

STATE OF MICHIGAN PROBATE COURT COUNTY
CIRCUIT COURT - FAMILY DIVISION

FILE NO. PETITION FOR APPOINTMENT OF GUARDIAN OF MINOR XXX-XXLast four digits of SSN

In the matter of 1. I,
Name (type or print)

, a minor

, am interested in the welfare of the minor and make this .
County City/Township

petition as

Relationship to minor (i.e. grandparent, uncle, friend, limited guardian, etc.)

2. The minor was born
Date

, is

female,

male, is unmarried, resides in

at

Address

State, zip

, and is presently located in

County City/Township

at

Address (only if different than above)

.
State, zip

The minor is a citizen of the following foreign country: 3. The persons interested in this proceeding are:
NAME RELATIONSHIP ADDRESS

Father/Age Mother/Age Conservator Guardian Person with care/ custody of minor*
* also list persons who had principal care and custody of minor during the two months preceding filing of petition

If neither parent is living, the names and addresses of the minor's grandparents and nearest of kin who are adults are:
NAME RELATIONSHIP ADDRESS

None of these persons is under any legal incapacity except (give name, incapacity, and representative of the person if any):

(PLEASE SEE OTHER SIDE)
Do not write below this line - For court use only

PC 651 (9/06)

PETITION FOR APPOINTMENT OF GUARDIAN OF MINOR

MCL 700.5204, MCL 700.5213

4. An action within the jurisdiction of the family division of circuit court involving the family or family members of the minor has been previously filed in assigned to Judge Court, Case Number , and remains is no longer , was pending.

5. The minor is a member of/eligible for membership in an American Indian tribe/band: Name of tribe/band 6. The minor is in need of a guardian because: a. The parental rights of both parents or of the surviving parent have been terminated or suspended by: death (certificate attached). a prior court order other than an order appointing a limited disappearance. guardian of the minor (copy attached) confinement in a place of detention. judgment of divorce or separate maintenance (copy attached). judicial determination of mental incompetency (order attached). OR b. The parent(s) permit the minor to reside with another person and do not provide that other person with the legal authority for the care and maintenance of the minor and the minor is not residing with a parent at this time. OR c. The biological parents of the minor were never married to each other and , the custodial parent died has disappeared since , and the other parent has not been granted legal custody by court order. The proposed guardian is related to the minor within the fifth degree by marriage, blood, or adoption. 7. A temporary guardian is necessary because:

I REQUEST: 8.
Name City/Township State Zip

whose address is
Address

be appointed guardian of the minor.
Telephone no.

9. The court order the parent(s) to provide reasonable support for and visitation and contact with the minor.

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 Signature of petitioner Address City, state, zip Telephone no. Date Signature of petitioner Address City, state, zip Telephone no.

10. I am 14 years of age or older. I nominate who lives at
Address

Name City State

as my guardian

Zip

Date

Signature of minor

Attorney signature Attorney name (type or print) Bar no.

Address City, state, zip Telephone no.