Free jc92.pmd - Michigan

Approved, SCAO

JIS CODE: AOT

STATE OF MICHIGAN
JUDICIAL CIRCUIT - FAMILY DIVISION

CASE NO. ACCEPTANCE OF APPOINTMENT (JUVENILE GUARDIAN)
Court telephone no.

COUNTY
Court address

1. In the matter of
name, alias(es), DOB

2. I have been appointed juvenile guardian of the child named above. 3. I accept the appointment, submit to personal jurisdiction of the court, will not delegate my authority, and agree to file reports and to perform required duties.

Date

Signature of juvenile guardian Name (type or print) Address City, state, zip Date of birth Telephone no.

Do not write below this line - For court use only

JC 92 (6/09)

ACCEPTANCE OF APPOINTMENT (JUVENILE GUARDIAN)

MCL 700.5215, MCR 3.979(B), (E)