STATE OF MICHIGAN

PROBATE COURT
COUNTY

NOTICE OF GUARDIANSHIP 
PROCEEDINGS
CONCERNING AN INDIAN CHILD

CASE NO. and JUDGE

Court address             

Court telephone no.

In the matter of 

First, middle, and last name of minor Indian child

TO: 

(Name and telephone no. of natural 
parent or Indian custodian. State if 
unknown.)  

(Name and telephone no. of natural 
parent or Indian custodian. State if 
unknown.) 

(Name and telephone no. of ICWA 
Designated Tribal Agent. See list 
here. State if unknown.) 

(Use only if identity of parents, 
custodian, or tribe is unknown.
If grandparent(s) are known, please
provide name(s) and date(s) of birth 
on Personal Identifying Information 
Form [MC 97a].)

 .

Midwest Regional Director, Bureau of Indian Affairs
5600 West American Blvd., Suite 500
Norman Pointe II Building
Bloomington, MN  55437
(612) 725-4500

TAKE NOTICE:
1. A petition regarding guardianship of the Indian child named above has been filed. A hearing will be held on this petition

on 

Date and time

  at 

Location

2. A copy of the petition is attached to this notice.

3. You have the absolute right to intervene in this proceeding and, absent objection by either Indian parent, you have the

right to petition the court to have this case transferred to the Tribal court of the

Tribe. The Tribal court may decline the transfer.

4. You may object to a transfer of this case to the Tribal court.

Approved, SCAO 
Form PC 678, Rev. 6/21
MCL 712B.9, MCL 712B.13(1)(b), MCL 712B.15(1)(a), MCL 712B.25(6),
25 USC 1912, MCR 5.109(1), MCR 5.404(B)(2), MCR 5.404(C)(1)
Page 1 of 2

Distribute form to: 
Court 
Copies as needed

JIS Code: NGPNotice of Guardianship Proceedings Concerning an Indian Child 
Page 2 of 2

(6/21) 

Case No. 
 

5. As a parent or Indian custodian, you have the right to a court-appointed attorney if you are determined indigent. If you
intend to request a court-appointed attorney, you should contact the court immediately by telephone or in writing.
 

If you choose to attend this hearing and you require accommodations to use the court because of a disability or if you
require a foreign language interpreter to help you fully participate in court proceedings, please contact the court 
immediately to make arrangements.

USE NOTE: This notice must be sent to the parties by personal service or registerd mail, return receipt requested.