In the matter of 
 

1. Date of hearing: 
 

THE COURT FINDS:

 , an individual with an alleged developmental disability

 Judge: 

Bar no.

2. A petition was filed requesting the appointment of an emergency temporary guardian for 

Name

3. Notice of hearing was   

 provided to all interested persons. 

 waived by all interested persons. 

 waived by the court.

4. 

Name

 is an individual with an alleged developmental disability.

5. Based on clear and convincing evidence, an emergency exists and 

 needs the immediate

Name

  protection of a temporary guardian of the 

 

 person, 

 

 estate, 

  pending a full hearing in this matter.

 , whose address and telephone number are 

Address

                                                                                 City                                                      State                                   Zip                                Telephone no.

is appointed temporary guardian of the 

 

 person 

 estate 

 

for 
 

7. The temporary guardian shall have the authority to do the following: 
 

 .

IT IS ORDERED:

6. 

Name (type or print)

 

 

 

 

 

 

8. The temporary guardian shall qualify by filing an acceptance of appointment. 

 must be filed.

 Bond at $ 
  

9. The temporary guardianship shall expire on 
 
 

then on the date of the hearing.

 or, if a hearing pursuant to statute is held earlier,

 10. 

Name of agency (e.g., community mental health)

 shall perform the necessary tests and report to accompany this

 

      petition at least one day before the scheduled hearing in this matter.

Judge                                                                                                     Bar no.

Date

 

Attorney name (type or print)

Address                                                                                                City                                            State                   Zip                                    Telephone no.

Do not write below this line - For court use onlyPC 679 (12/18) ORDER APPOINTING EMERGENCY TEMPORARY GUARDIAN FOR INDIVIDUAL WITH                        ALLEGED DEVELOPMENTAL DISABILITYMCL 330.1607, MCR 5.104Approved, SCAO JIS CODE: OEGSTATE OF MICHIGANPROBATE COURTCOUNTY OFORDER APPOINTING EMERGENCYTEMPORARY GUARDIAN FOR INDIVIDUALWITH ALLEGED DEVELOPMENTAL DISABILITYFILE NO.