STATE OF MICHIGAN

PROBATE COURT
COUNTY

PETITION TO USE FUNDS
(CONSERVATORSHIP)

CASE NO. and JUDGE

Court address              

 

 

 

Court telephone no.

In the matter of 

First, middle, and last name

Petitioner’s name, address, and telephone no.

Petitioner’s attorney, bar no., address, and telephone no.

2. The interested persons, addresses, and their representatives are identical to those appearing on the initial application/
  petition, except as follows: (For each person whose address changed, list the name and new address; attach separate sheet if necessary.) 

 , am conservator of the estate.

4. I REQUEST permission to withdraw $ 

 of the ward’s money from 

 

Name of financial institution

 . The funds will be used as follows for the benefit of the ward:

 .

Put account no. in 
Ref. No. row 6 on MC 97.
Account no. 

 at 

 the ward’s total assets are $ 
 

1. I, 

Name

 

3. As of 

Date

   

 

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

 

 

Petitioner signature

Attorney signature

 

Approved, SCAO
Form PC 673m, Rev. 5/21
MCL 700.5427
Page 1 of 1

JIS Code: PUF

PC 673m, Petition to Use Funds (Conservatorship)

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About This Form:

• Sourced from www.courts.michigan.gov/conservatorship-protected-individuals (2023-03)
• Page(s): 1
• Fields(s): 19
• Average fields per page: 19
• Reading Level: Grade 8
• LIST Grouping(s): CO-00-00-00-00, CO-07-00-00-00.

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