Petition For Appointment Of Guardian
ADVERTISEMENT
1
2
3JIS CODE: PCS-PEG
Approved, SCAO
TCS-PGII
FILE NO.
STATE OF MICHIGAN
PETITION FOR
PROBATE COURT
APPOINTMENT OF GUARDIAN OF
COUNTY OF
INCAPACITATED INDIVIDUAL
XXX-XX-
A
In the matter of
Alleged incapacitated individual
Last four digits of SSN
Date of birth
Race
Sex
Address of alleged incapacitated individual where now found
B
C
1. I,
, am interested in this matter
Name (type or print)
and make this petition as
.
State interest/relationship
D
2. An action within the jurisdiction of the family division of circuit court involving the family or family members of the person
named above has been previously filed in
Court, Case Number
, was
assigned to Judge
, and
remains
is no longer
pending.
E
3. The adult is a resident of
,
City, village, or township
County
State
and has a home address and telephone number of
Address
.
City
State
Zip
Telephone no.
The individual is a citizen of the following foreign country:
F
4. The adult has
a patient advocate/power of attorney for health care.
(Specify name and address below.)
a power of attorney.
(Specify name and address below.)
a conservator.
(Specify name and address below.)
Name and address
G
5.
The patient advocate designation was not executed in compliance with MCL 700.5506.
The patient advocate is not complying with the terms of the designation or of MCL 700.5506 to MCL 700.5512.
The patient advocate is not acting consistent with the ward's best interests.
H
6. The adult lacks sufficient understanding or capacity to make or communicate informed decisions because of
mental illness.
mental deficiency.
physical illness or disability.
chronic intoxication.
chronic drug use.
.
7. Specific facts about the adult's recent condition or conduct that lead me to believe the adult needs a guardian are
I
(Attach a separate sheet if more space is needed.)
8. The name, address, and telephone number of the person/agency (if any) who currently has care and custody of the adult
J
are
.
(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 700.1105(a), MCL 700.5303, MCR 3.206(A)(4),
MCR 5.125(C)(22), MCR 5.402(A)
PETITION FOR APPOINTMENT OF GUARDIAN OF INCAPACITATED INDIVIDUAL
PC 625 (9/13)
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