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Here is the text we could read:

STATE OF MICHIGAN

CASE NO. and JUDGE

PROBATE COURT
COUNTY

APPLICATION FOR APPOINTMENT
OF OUT-OF-STATE GUARDIAN OF
LEGALLY INCAPACITATED INDIVIDUAL

Court address

Court telephone no.

In the matter of

First, middle, and last name

Last four digits of SSN

Court ORI*

Date of birth

Put DOB in Ref. No.
row 1 on MC 97.
*Court ORI is to be completed by the court.

1. I,

Name (type or print)

Race

Sex Address of incapacitated individual where now found

, am interested in this matter

and make this application as the individual’s guardian appointed, qualified, and serving in good standing in another state.

2. I am not aware of any guardianship or pending petitions in this state for a guardianship of the individual.

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

Case Number

and

remains

is no longer

pending.

, was assigned to Judge

Court,

4. The alleged incapacitated individual has

a spouse
whose name(s) and address(es) are listed below.
no spouse, adult child(ren), or parent(s). The names and addresses of presumptive heirs** are listed below.
none of the above. (must notify the Attorney General***)

adult child(ren)

living parent(s)

NAME

RELATIONSHIP

ADDRESS AND TELEPHONE NUMBER

Street address

City

State

Zip

Telephone no.

State

Zip

Telephone no.

State

Zip

Telephone no.

**Presumptive heirs includes minor children, if any.
***Notify the Attorney General by sending a copy of this form to: Attorney General, Public Administration, PO Box 30755, Lansing, MI 48909.

Approved, SCAO
Form PC 685m, Rev. 5/21
MCL 700.1105(a), MCL 700.5301a, MCR 5.107, MCR 5.125(C)(23)
Page 1 of 2

PCS Code: AOG TCS Code: AAOGPetitioner’s name, address and telephone no.Petitioner’s attorney, bar no., address, and telephone no.Put last 4 digits of SSN in Ref. No. row 2 on MC 97.XXX-XX-Application for Appointment of Out-of-State Guardian of Legally Incapacitated Individual
Page 2 of 2

(5/21)

Case No.

4. (continued)
None of these persons are under any legal incapacity except

Name, incapacity, and representative of the person, if any

5. The individual

is not entitled to receive Veterans Administration benefits. The Veterans Administration

claimant number is

6. The adult is a resident of

and has a home address and telephone number of

Address

City, village, or township

County State

City, State, Zip Telephone no.

The individual is a citizen of the following foreign country:

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.)

8. The name, address, and telephone number of the person/agency (if any) who currently has care and custody of the

Name of court that appointed guardian State Telephone no.

appointed the guardian for the following reason(s):

10. I REQUEST that the court of this state appoint me guardian of the individual in accordance with the laws of this state.

I declare under the penalties of perjury that this application has been examined by me and that its contents are true to the
best of my information, knowledge, and belief.

Applicant signature

Attorney signature

7. The adult has

Name and address

individual are

Date

PC 685m, Application for Appointment of Out-of-state Guardian of Legally Incapacitated Individual

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/conservatorship-protected-individuals (2023-03)
Page(s): 2
Fields(s): 70
Average fields per page: 35
Reading Level: Grade 9
LIST Grouping(s): Unknown

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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)
put_last_digits_ss_n was Put last 4 digits of SSN in (0.35 conf)
first_middle_last_name was First middle and last name (0.37 conf)
petitioners_name_address was Petitioners name address and telephone no (0.40 conf)
petitioners_attorney_address was Petitioners attorney bar no address and telephone no (0.52 conf)
court_ori was Court ORI (0.49 conf)
race was Race (0.41 conf)
sex was Sex (0.38 conf)
address_individual_found was Address of incapacitated individual where now found (0.48 conf)
name_type_print was Name type or print (0.45 conf)
action_division_involving was 3 An action within the jurisdiction of the family division of circuit court involving the family or family members of the (0.42 conf)
court was Court (0.45 conf)
remains was remains (0.32 conf)
longer was is no longer (0.37 conf)
pending was pending (0.47 conf)
undefined__1 was undefined (0.38 conf)
spouse was a spouse (0.35 conf)
spouse_presumptive_heirs was no spouse adult children or parents The names and addresses of presumptive heirs are listed below (0.47 conf)
none_must_attorney_general was none of the above must notify the Attorney General (0.38 conf)
adult_children was adult children (0.48 conf)
living_parents was living parents (0.34 conf)
name_row__1 was NAMERow1 (0.43 conf)
relationship_row__1 was RELATIONSHIPRow1 (0.39 conf)
users1_address_line_one__1 was Street address (1.00 conf)
users1_address_city was City (1.00 conf)
users1_address_state was State (1.00 conf)
users1_address_zip was Zip (1.00 conf)
telephone__1 was Telephone no (0.44 conf)
name_row__2 was NAMERow2 (0.43 conf)
relationship_row__2 was RELATIONSHIPRow2 (0.39 conf)
street_address__1 was Street address_2 (0.43 conf)
city__1 was City_2 (0.39 conf)
state__1 was State_2 (0.39 conf)
zip__1 was Zip_2 (0.36 conf)
telephone__2 was Telephone no_2 (0.45 conf)
name_row__3 was NAMERow3 (0.43 conf)
relationship_row__3 was RELATIONSHIPRow3 (0.39 conf)
street_address__2 was Street address_3 (0.43 conf)
city__2 was City_3 (0.39 conf)
state__2 was State_3 (0.39 conf)
zip__2 was Zip_3 (0.36 conf)
telephone__3 was Telephone no_3 (0.45 conf)
judge was Judge (0.39 conf)
text__1 was Text2 (0.35 conf)
name_representative_person was Name incapacity and representative of the person if any (0.34 conf)
is was is (0.32 conf)
is_not was is not (0.34 conf)
undefined__2 was undefined_2 (0.39 conf)
city_village_township was City village or township (0.33 conf)
county was County (0.39 conf)
state__3 was State_4 (0.39 conf)
users1_address_line_one__2 was Address (1.00 conf)
city_state_zip was City State Zip (0.35 conf)
individual_following_foreign was The individual is a citizen of the following foreign country (0.35 conf)
telephone__4 was Telephone no_4 (0.45 conf)
patient_health_address was a patient advocatepower of attorney for health care Specify name and address below (0.42 conf)
attorney_specify_name_address was a power of attorney Specify name and address below (0.39 conf)
conservator_specify_name_address was a conservator Specify name and address below (0.42 conf)
name_address was Name and address (0.37 conf)
undefined__3 was undefined_3 (0.39 conf)
name_appointed_guardian was Name of court that appointed guardian (0.47 conf)
state__4 was State_5 (0.39 conf)
telephone__5 was Telephone no_5 (0.45 conf)
appointed_following_reasons__1 was appointed the guardian for the following reasons 1 (0.40 conf)
appointed_following_reasons__2 was appointed the guardian for the following reasons 2 (0.40 conf)
signature_date__1 was Date (1.00 conf)
signature_date__2 was Date_2 (1.00 conf)
text__2 was Text3 (0.35 conf)
text__3 was Text4 (0.35 conf)
text__4 was Text5 (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 685m, Application for Appointment of Out-of-state Guardian of Legally Incapacitated Individual

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