Form Pc 654 - Annual Report Of Guardian On Condition Of Minor

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PCS CODE: AGM

TCS CODE: AGM

Approved, SCAO

STATE OF MICHIGAN

FILE NO.

PROBATE COURT

ANNUAL REPORT OF GUARDIAN

COUNTY

ON CONDITION OF MINOR

This report should be completed annually by the guardian, or more often if directed by the court.

In the matter of

, minor

First, middle, and last name

1. I,

, am the guardian of the above named minor and my annual

Name (type or print)

report for the period

is as follows:

Date

2. Present age of the minor:

Minor's date of birth:

3. Living Arrangement

a. The current address and telephone number of the minor are:

Check here if this is a new address

b. The minor's residence is:

guardian's home

relative's home:

other:

Relationship

c. The minor has been in the present residence since

. If moved within the past year, state

Date

the changes and the reasons for change:

d. I rate the minor's living arrangement as

excellent.

average.

below average.

e. I believe the minor is

content with the living situation.

unhappy with the living situation.

f. I recommend a more suitable living arrangement for the minor as follows:

4. Physical Health

a. The minor's current physical condition is

excellent.

good.

fair.

poor.

b. During the past year the minor's physical condition has

remained about the same.

improved.

Explain

worsened.

Explain

c. During the past year the minor received the following medical treatment (include check-ups and optical and dental work):

Date

Ailment

Type of Treatment

Doctor’s Name

(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

ANNUAL REPORT OF GUARDIAN ON CONDITION OF MINOR

PC 654 (12/17)

MCL 700.5215(f), MCR 5.409(A)