Form PC650 "Petition for Appointment of Limited Guardian of Minor" - Michigan

What Is Form PC650?

This is a legal form that was released by the Michigan Probate Court - a government authority operating within Michigan. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on December 1, 2017;
  • The latest edition provided by the Michigan Probate Court;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form PC650 by clicking the link below or browse more documents and templates provided by the Michigan Probate Court.

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Download Form PC650 "Petition for Appointment of Limited Guardian of Minor" - Michigan

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Approved, SCAO
JIS CODE: LGM
STATE OF MICHIGAN
FILE NO.
PROBATE COURT
PETITION FOR APPOINTMENT OF
COUNTY OF
LIMITED GUARDIAN OF MINOR
XXX-XX-
In the matter of
, a minor
First, middle, and last name
Last four digits of SSN
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
Court, Case Number
, was
assigned to Judge
, and
remains
is no longer
pending.
3. The minor was born
, is
female,
male, is unmarried, resides in
Date
County
at
Address
City/Township
State
Zip
and is presently located in
at
County
Address (only if different than above)
.
City/Township
State
Zip
The minor is a citizen of the following foreign country:
.
4.
The minor is not an Indian child as defined in MCR 3.002(12).
It is unknown whether the minor is an Indian child as defined in MCR 3.002(12).
*Also list persons who had principal care and custody of the minor
5. The persons interested in this proceeding are:
during the 63 days before filing the petition.
NAME
RELATIONSHIP
ADDRESS AND TELEPHONE NUMBER
Street address
Parent/DOB
City
State
Zip
Telephone no.
Street address
Parent/DOB
City
State
Zip
Telephone no.
Street address
Conservator
City
State
Zip
Telephone no.
Street address
Guardian
City
State
Zip
Telephone no.
Street address
Person with care/
City
State
Zip
Telephone no.
custody of minor*
None of these persons are under any legal incapacity except
.
Name, incapacity, and representative of the person, if any
(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 700.5205,
PETITION FOR APPOINTMENT OF LIMITED GUARDIAN OF MINOR
PC 650 (12/17)
MCR 5.125(C)(19), MCR 5.404
Approved, SCAO
JIS CODE: LGM
STATE OF MICHIGAN
FILE NO.
PROBATE COURT
PETITION FOR APPOINTMENT OF
COUNTY OF
LIMITED GUARDIAN OF MINOR
XXX-XX-
In the matter of
, a minor
First, middle, and last name
Last four digits of SSN
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
Court, Case Number
, was
assigned to Judge
, and
remains
is no longer
pending.
3. The minor was born
, is
female,
male, is unmarried, resides in
Date
County
at
Address
City/Township
State
Zip
and is presently located in
at
County
Address (only if different than above)
.
City/Township
State
Zip
The minor is a citizen of the following foreign country:
.
4.
The minor is not an Indian child as defined in MCR 3.002(12).
It is unknown whether the minor is an Indian child as defined in MCR 3.002(12).
*Also list persons who had principal care and custody of the minor
5. The persons interested in this proceeding are:
during the 63 days before filing the petition.
NAME
RELATIONSHIP
ADDRESS AND TELEPHONE NUMBER
Street address
Parent/DOB
City
State
Zip
Telephone no.
Street address
Parent/DOB
City
State
Zip
Telephone no.
Street address
Conservator
City
State
Zip
Telephone no.
Street address
Guardian
City
State
Zip
Telephone no.
Street address
Person with care/
City
State
Zip
Telephone no.
custody of minor*
None of these persons are under any legal incapacity except
.
Name, incapacity, and representative of the person, if any
(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 700.5205,
PETITION FOR APPOINTMENT OF LIMITED GUARDIAN OF MINOR
PC 650 (12/17)
MCR 5.125(C)(19), MCR 5.404
Petition for Appointment of Limited Guardian of Minor (12/17)
File No.
6. The welfare of the minor will be served by the appointment.
7. A proposed limited guardianship placement plan is attached.
I REQUEST:
8.
whose address is
Name
Address
be appointed limited guardian of the minor.
City/Township
State
Zip
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
Date
/s/
/s/
Signature of custodial parent
Signature of custodial parent
Address
Address
City, state, zip
Telephone no.
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
as my guardian
Name
who lives at
.
Address
City
State
Zip
/s/
Date
Signature of minor
/s/
Attorney signature
Attorney name (type or print)
Bar no.
Address
City, state, zip
Telephone no.
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).
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