Petition For Appointment Of Conservator/protective Order

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PCS CODE: CSR

Approved, SCAO

TCS CODE: CSV

STATE OF MICHIGAN

FILE NO.

PETITION FOR

PROBATE COURT

APPOINTMENT OF CONSERVATOR

COUNTY OF

PROTECTIVE ORDER

Estate of

Individual alleged to need protection (first, middle, and last name)

Last four digits of SSN

1. I,

, am interested in this matter

Name

and make this petition as

State interest/relationship

2. The individual was born

, resides in

County

Date

Address

and has property in

County.

City, state, zip

3. An action within the jurisdiction of the family division of circuit court involving the family or family members of the above

individual has been previously filed in

Court, Case Number

, was

assigned to Judge

, and

remains

is no longer

pending.

4. The individual has

a power of attorney.

(Specify name and address below.)

a guardian.

(Specify name and address below.)

a representative payee for social security.

(Specify name and address below.)

Name and address

a. The individual is an adult unable to manage his/her property and business affairs effectively because of

mental illness

chronic use of drugs

detention by a foreign power

mental deficiency

chronic intoxication

disappearance

physical illness or disability

confinement

and either

the adult has property that will be wasted or dissipated unless proper management is provided, or

the adult or his/her dependents are in need of money for support, care, and welfare, and protection is necessary

to obtain or provide money.

b. The adult petitioner is mentally competent but because of age or physical infirmity is unable to manage his/her

property and affairs effectively, and recognizing the disability, requests appointment of a conservator.

c. The individual is a minor who

owns money or property that requires management or protection that cannot otherwise be provided.

has or may have business affairs that may be jeopardized or prevented by minority.

needs money for support and education, and protection is necessary or desirable to obtain or provide money.

d. I am the guardian of the ward and it is in the ward's best interests to sell or otherwise dispose of the ward's real

property or interest in real property.

6. The statements in item 5 are supported by the following facts:

(Attach a separate sheet.)

(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 700.5104(2), MCL 700.5215(a), MCL 700.5314(b), MCL 700.5401, MCL 700.5404, MCR 3.206(A)(4), MCR 5.105(C),

PETITION FOR APPOINTMENT OF CONSERVATOR AND/OR PROTECTIVE ORDER

PC 639 (9/16)

MCR 5.125(C)(24)