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STATE OF MICHIGAN

CASE NO. and JUDGE

PROBATE COURT
COUNTY

ANNUAL REPORT OF GUARDIAN
ON CONDITION OF MINOR

Court address

Court telephone no.

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

In the matter of

First, middle, and last name of minor

1. I,

Name (type or print)

annual report for the period

Date

2. Present age of the minor:

, am the guardian of the above named minor and my

Date

is as follows:

3. Living Arrangement
a. The current address and telephone number of the minor are:
b. The minor's residence is:

guardian's home

relative's home:

Relationship

other:

Check here if this is a new address

c. The minor has been in the present residence since
state the changes and the reasons for change:

Date

. If moved within the past year,

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

remained about the same.
improved.

worsened.

Explain

excellent.

good.

fair.

poor.

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

Type of Treatment

Doctor’s Name

Ailment

Approved, SCAO
Form PC 654, Rev. 12/22
MCL 700.5215(f), MCR 5.409(A)
Page 1 of 3

JIS Code: AGM .

Annual Report of Guardian on Condition of Minor
Page 2 of 3

(12/22)

Case No.

5. Education

a. The minor regularly attends school at

and is in grade

b. The minor attends alternative education at

and is in grade

c. The minor does not attend school because

6. Activities of Minor
a. The minor's social activities (including sports) are:

b. During the past year the minor has been in counseling with

c. During the past year the minor received in-patient services at

7. Parenting time between the minor and parents was as follows:

a. Parent’s name and current address:

b. Parent’s name and current address:

Parenting time:

c. Comments about parenting time:

8. Parents complied with the

court-structured plan

limited guardianship placement plan

as follows:

Changes should be made to the plan as follows:

am not

willing to continue to serve as guardian.

NOTE: If you no longer wish to serve, you must file a Petition to Terminate/Modify Guardianship (PC 675).

11. As guardian, I have been ordered by the court to file an annual account, which is attached.

Signature of guardian

Signature of co-guardian (if applicable)

ity, state, zip Telephone no.

City, state, zip Telephone no.

Check here if this is a new address

Date

Address

10. I

Date

Address

Annual Report of Guardian on Condition of Minor
Page 3 of 3

(12/22)

Case No.

9. The guardianship

should

should not

be continued because:

PC 654, Annual Report of Guardian on Condition of Minor

This info page is part of the LIT Lab's Form Explorer project. It is not associated with the Michigan state courts. To learn more about the project, check out our about page.

Downloads: You can download both the original form (last checked 2023-03) and the machine-processed form with normalized data fields.

About This Form:

Sourced from www.courts.michigan.gov/guardianship (2023-03)
Page(s): 3
Fields(s): 93
Average fields per page: 31
Reading Level: Grade 7
LIST Grouping(s): FA-00-00-00-00.

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Identified Data Fields:

We have done our best to automaticly identify and name form fields according to our naming conventions. When possible, we've used names tied to our question library. See e.g., user1_name. If we think we've found a match to a question in our library, it is highlighted in green. Novel names are auto generated. So, you will probably need to edit some of them if you're trying to stick to the convention.

Here are the fields we could identify.

stat_e_f_michiga_n_probat_cour_county was STATE OF MICHIGAN PROBATE COURT COUNTY (0.62 conf)
report_completed_often was This report should be completed annually by the guardian or more often if directed by the court (0.35 conf)
name_type_print was Name type or print (0.45 conf)
to was to (0.43 conf)
guardian_named_minor was am the guardian of the above named minor and my (0.44 conf)
signature_date__1 was Date (1.00 conf)
undefined__1 was undefined (0.38 conf)
current_number_minor was a The current address and telephone number of the minor are (0.36 conf)
guardians_home was guardians home (0.45 conf)
relatives_home was relatives home (0.49 conf)
other was other (0.43 conf)
check_new_address__1 was Check here if this is a new address (0.32 conf)
undefined__2 was undefined_2 (0.39 conf)
relationship was Relationship (0.39 conf)
state_changes_reasons_change was state the changes and the reasons for change (0.36 conf)
excellent__1 was excellent (0.32 conf)
average__1 was average (0.32 conf)
average__2 was below average (0.35 conf)
content_living_situation was content with the living situation (0.30 conf)
unhappy_living_situation was unhappy with the living situation (0.31 conf)
suitable_minor_follows was f I recommend a more suitable living arrangement for the minor as follows (0.35 conf)
undefined__3 was undefined_3 (0.39 conf)
excellent__2 was excellent_2 (0.35 conf)
good was good (0.45 conf)
fair was fair (0.32 conf)
poor was poor (0.41 conf)
remained was remained about the same (0.37 conf)
improved was improved (0.38 conf)
worsened was worsened (0.35 conf)
undefined__4 was undefined_4 (0.39 conf)
explain was Explain (0.40 conf)
judge was Judge (0.39 conf)
text__1 was Text2 (0.35 conf)
text__2 was Text3 (0.35 conf)
text__3 was Text4 (0.35 conf)
signature_date__2 was Date1 (1.00 conf)
signature_date__3 was Date2 (1.00 conf)
signature_date__4 was Date3 (1.00 conf)
ailment__1 was Ailment1 (0.35 conf)
ailment__2 was Ailment2 (0.35 conf)
ailment__3 was Ailment3 (0.35 conf)
type__1 was Type1 (0.43 conf)
type__2 was Type2 (0.38 conf)
type__3 was Type3 (0.35 conf)
doctor__1 was Doctor1 (0.35 conf)
doctor__2 was Doctor2 (0.35 conf)
doctor__3 was Doctor3 (0.35 conf)
undefined__5 was undefined_5 (0.39 conf)
minor_regularly_attends was a The minor regularly attends school at (0.35 conf)
minor_alternative_education was b The minor attends alternative education at (0.33 conf)
c_minor_attend_school was c The minor does not attend school because (0.29 conf)
grade__1 was and is in grade (0.31 conf)
undefined__6 was undefined_6 (0.39 conf)
grade__2 was and is in grade_2 (0.37 conf)
undefined__7 was undefined_7 (0.39 conf)
minors_social_including was a The minors social activities including sports are (0.35 conf)
undefined__8 was undefined_8 (0.39 conf)
b_past_year_minor_counseling was b During the past year the minor has been in counseling with (0.28 conf)
at was at (0.35 conf)
past_year_minor_inpatient was c During the past year the minor received inpatient services at (0.35 conf)
parents_name_current_address was a Parents name and current address (0.39 conf)
parenting_time__1 was Parenting time (0.32 conf)
b_parents_name_current_address was b Parents name and current address (0.40 conf)
parenting_time__2 was Parenting time_2 (0.28 conf)
c_comments_parenting_time was c Comments about parenting time (0.36 conf)
unknown__1 was 1 (0.38 conf)
unknown__2 was 2 (0.38 conf)
courtstructured_plan was courtstructured plan (0.36 conf)
limited_placement_plan was limited guardianship placement plan (0.34 conf)
parents_complied__1 was 9 Parents complied with the 1 (0.41 conf)
parents_complied__2 was 9 Parents complied with the 2 (0.41 conf)
changes_made_plan_follows__1 was Changes should be made to the plan as follows 1 (0.35 conf)
changes_made_plan_follows__2 was Changes should be made to the plan as follows 2 (0.35 conf)
text__4 was Text5 (0.35 conf)
should was should (0.36 conf)
should_not was should not (0.43 conf)
continued was be continued because (0.39 conf)
guardianship__1 was 10 The guardianship 1 (0.40 conf)
guardianship__2 was 10 The guardianship 2 (0.40 conf)
am was am (0.45 conf)
am_not was am not (0.50 conf)
ordered_annual_account was 12 As guardian I have been ordered by the court to file an annual account which is attached (0.37 conf)
signature_date__5 was Date_2 (1.00 conf)
users1_address_line_one was Address (1.00 conf)
users1_address_line_two was City state zip (1.00 conf)
telephone__1 was Telephone no (0.44 conf)
signature_date__6 was Date_3 (1.00 conf)
address was Address_2 (0.35 conf)
city_state_zip was City state zip_2 (0.35 conf)
telephone__2 was Telephone no_2 (0.45 conf)
check_new_address__2 was Check here if this is a new address_2 (0.33 conf)
undefined__9 was undefined_9 (0.39 conf)
text__5 was Text6 (0.35 conf)
text__6 was Text7 (0.35 conf)

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The Legal Innovation & Technology Lab's Form Explorer Beta @ Suffolk Law School Last updated 2023-04-02

PC 654, Annual Report of Guardian on Condition of Minor

About This Form:

Identified Data Fields:

Create an Interactive Version of this Form:

The Legal Innovation & Technology Lab's Form Explorer ^Beta @ Suffolk Law School Last updated 2023-04-02