PCS CODE: AGW
Approved, SCAO
TCS CODE: AGW
STATE OF MICHIGAN
FILE NO.
ANNUAL REPORT OF GUARDIAN ON
PROBATE COURT
CONDITION OF
COUNTY OF
LEGALLY INCAPACITATED INDIVIDUAL
FINAL REPORT
NOTE: This report must be completed yearly by the guardian, or more often if directed by the court. The guardian must serve
the completed report on the ward and all interested persons as required by Michigan Court Rules 5.105 and 5.125.
Then the guardian must complete a proof of service (form PC 564) and file it and this report with the court.
In the matter of
, a legally incapacitated indidvidual
First, middle, and last name
1. I,
, am the guardian of the adult named above and my annual
Name (type or print)
report for the period of
to
is as follows.
Date
Date
2. Present age of the adult:
Date of birth:
3. Living Arrangement
a. The current address and telephone number of the adult are:
Check here if this is a new address
b. The name of the facility where the adult resides, if any:
c. The adult's residence is:
own home/apartment
guardian's home/apartment
other:
(boarding home, assisted living, etc.)
nursing home
hospital or medical facility
foster home
relative's home:
Relationship
d. The adult has been in the present residence since
. If moved within the past year, state
Date
the changes and the reasons for change.
e. I rate the adult's living arrangement as
excellent.
average.
below average.
Explain
f. I believe the adult is
content with the living situation.
unhappy with the living situation.
g. I recommend a more suitable living arrangement for the adult as follows:
(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
MCL 700.5314(e), (g), MCL 700.5317, MCR 5.409(A)
ANNUAL REPORT OF GUARDIAN ON CONDITION OF LEGALLY INCAPACITATED INDIVIDUAL
PC 634 (9/16)