Approved, SCAO

STATE OF MICHIGAN

PROBATE COURT
COUNTY
CIRCUIT COURT - FAMILY DIVISION

In the matter of

CERTIFICATE OF LEGAL COUNSEL /
WAIVER OF ATTENDANCE

JIS CODE:  CLC/WOA

FILE NO.

1. I have been appointed by the court as legal counsel for the individual named above.

CERTIFICATE OF LEGAL COUNSEL

2. A hearing on the petition for admission/hospitalization/assisted outpatient treatment has been set as follows:

Date:

Time:

Location:

Judge:

3. I certify that I personally have seen and consulted with the individual at least 24 hours before the time set for the hearing.

Date

Signature of attorney

Bar no.

Attorney name (type or print)

Address

City, state, zip

Telephone no.

I understand that it is my right to be present at the hearing on the petition for admission/hospitalization/assisted outpatient treatment
set for the date stated above but I waive that right.

WAIVER OF ATTENDANCE

Date

Signature of the individual named above

        Witness:

Signature of legal counsel

Do not write below this line - For court use only

PCM 223   (9/07)   CERTIFICATE OF LEGAL COUNSEL / WAIVER OF ATTENDANCE

MCL 330.1454(1), MCL 330.1455(1)



Certificate of Legal Counsel/Waiver of Attendance

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About This Form:

• Sourced from www.courts.michigan.gov/MH-Forms (2023-03)
• Page(s): 1
• Fields(s): 15
• Average fields per page: 15
• Reading Level: Grade 7
• LIST Grouping(s): CO-07-00-00-00, CO-00-00-00-00.

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