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JIS CODE: OJG

STATE OF MICHIGAN
JUDICIAL CIRCUIT - FAMILY DIVISION

CASE NO. ORDER APPOINTING JUVENILE GUARDIAN
Court telephone no.

COUNTY
Court address

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

2.

After hearing before:

Upon review by:

Judge/Referee

Bar no.

THE COURT FINDS: 3. On , in case number best interest of the child to appoint a juvenile guardian over the child. 4. a. The parental rights over the child have not been terminated. b. The parental rights over the child were terminated on Michigan Children's Institute superintendent to the juvenile guardianship is not required because the child was not committed to MCI. . The written consent of the has been filed. is not required pursuant to MCR 3.979(A)(3)(c). , the court determined it to be in the

5. Placement of the child with a juvenile guardian continues to be necessary and appropriate. 6. The results of the required criminal record check and central registry have been submitted to the court. The homestudy of the juvenile guardian was submitted to the court pursuant to MCR 3.979(A)(1)(b). 7. There will be sufficient assets under the control of the juvenile guardian to require a conservatorship. IT IS ORDERED: 8.
Name (type or print) Address City State

, whose address and telephone number are
Zip Telephone no.

,

is appointed juvenile guardian of the child named above, and an acceptance of appointment shall be filed. Upon acceptance of the appointment, the juvenile guardian shall comply with all relevant requirements of MCL 700.5215 and MCR 3.979(E). 9. Other: (Include provisions such as parenting time or child support. When item 7 is checked, include a provision requiring the juvenile guardian to petition
the probate court for a conservator.)

Recommended by:
Date

Referee signature Judge Bar no.

Do not write below this line - For court use only

NOTE: A separate order must be entered for each child.

JC 91 (6/09)

ORDER APPOINTING JUVENILE GUARDIAN

MCL 712A.19a, MCL 712A.19c, MCR 3.979