Michigan > Statewide > Probate > Guardianships and Conservatorships
Petition For Appointment Of Limited Guardian Of Minor PC 650 - Michigan
| Petition For Appointment Of Limited Guardian Of Minor Form. This is a Michigan form and can be used in Guardianships and Conservatorships Probate Statewide . |
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Approved, SCAO JIS CODE: LGM STATE OF MICHIGAN PROBATE COURT COUNTY OF In the matter of FILE NO. PETITION FOR APPOINTMENT OF LIMITED GUARDIAN OF MINOR XXX-XXLast four digits of SSN , a minor USE NOTE: If a parent is incarcerated and under the jurisdiction of the Michigan Department of Corrections, the petitioner must comply with MCR 2.004(B). 1. I am interested in this matter and make this petition as custodial parent of the minor. 2. 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 3. The minor was born at Address Zip Date Court, Case Number , and , is female, remains is no longer County , was pending. male, is unmarried, resides in City/Township State , and is presently located in County City/Township at Address (only if different than above) Zip State . The minor is a citizen of the following foreign country: 4. The minor is a member of an Indian tribe, or is eligible for membership in an Indian tribe and is a biological child of a member of an Indian tribe. The name of the tribe is The minor is not an Indian child as defined in MCR 3.002(5). It is unknown whether the minor is an Indian child as defined in MCR 3.002(5). . 5. The persons interested in this proceeding are: NAME RELATIONSHIP ADDRESS Father/DOB Mother/DOB Conservator Guardian Person with care/ custody of minor* * Also list persons who had principal care and custody of the minor during the 63 days before filing the petition. (SEE SECOND PAGE) USE NOTE: If this form is being filed in the circuit court family division, please enter the court name and county in the upper left-hand corner of the form. Do not write below this line - For court use only PC 650 (9/11) PETITION FOR APPOINTMENT OF LIMITED GUARDIAN OF MINOR MCL 700.5205, MCR 5.125(C)(19), MCR 5.404 American LegalNet, Inc. www.FormsWorkFlow.com 6. The welfare of the minor will be served by the appointment. 7. A proposed limited guardianship placement plan is attached. I REQUEST: 8. Name City/Township State Zip whose address is Address be appointed limited guardian of the minor. Telephone no. 9. Other: 10. I CONSENT TO THE SUSPENSION OF MY PARENTAL RIGHTS. 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 custodial father Address City, state, zip Telephone no. Date Signature of custodial mother Address City, state, zip Telephone no. NOTE: If both parents have custody, each must sign. 11. I am 14 years of age or older. I nominate who lives at Address City State Zip Name as my guardian . Date Signature of minor Attorney signature Attorney name (type or print) Address City, state, zip Telephone no. Bar no. American LegalNet, Inc. www.FormsWorkFlow.com
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