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STATE OF MICHIGAN

PROBATE COURT
COUNTY

PETITION FOR APPOINTMENT
OF LIMITED GUARDIAN OF
MINOR INDIAN CHILD
(VOLUNTARY GUARDIANSHIP)

CASE NO. and JUDGE

Court address

Court telephone no.

In the matter of

First, middle, and last name

Name of tribe and identification no. (if one)

Petitioner’s name, address, and telephone no.

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

1. I am interested in this matter and make this petition as custodial parent or Indian custodian of the minor Indian child.

2. A consent to the voluntary guardianship will be or has been executed under MCL 712B.13 (form PC 686).

3. I consent to the suspension of my parental rights under MCL 700.5205.

4. The minor is currently

, is

female,

male, is unmarried, resides in

Age

County

Address City/Township State Zip

and is presently located in

County

Address (only if different than above)

City/Township State Zip

The minor is a citizen of the following foreign country:

5. An action within the jurisdiction of the family division of circuit court involving the family or family members of the minor

has been previously filed in

was assigned to Judge

6. The persons interested in this proceeding are:

NAME

RELATIONSHIP

Court, Case Number

, and

remains

is no longer pending.

Parent/Age

Street address

City

Street address

ADDRESS AND TELEPHONE NUMBER

State

Zip

Telephone no.

State

Zip

Telephone no.

Approved, SCAO
Form 650i, Rev. 5/21
MCL 700.5205, MCL 712B.13, MCL 712B.15, MCL 712B.25,
MCR 5.125(A)(4), MCR 5.125(C)(20), MCR 5.404
Page 1 of 2

JIS Code: LGIPetition for Appointment of Limited Guardian of Minor Indian Child
(Voluntary Guardianship)
Page 2 of 2

(5/21)

Case No.

6. (continued)
The persons interested in this proceeding are:

NAME

RELATIONSHIP

*Also list persons who had principal care and custody of the minor during
the 63 days before filing the petition.

ADDRESS AND TELEPHONE NUMBER

Conservator

Guardian

Person with care/
custody of minor*

Street address

City

State

Zip

Telephone no.

State

Zip

Telephone no.

State

Zip

Telephone no.

None of these persons are under any legal incapacity except

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

7. The welfare of the minor will be served by the appointment.

8. A proposed limited guardianship placement plan is attached.

City/Township State Zip Telephone no.

be appointed limited guardian of the minor.

whose address is

Address

I REQUEST:

Name

10. Other:

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.

Signature of custodial parent

Signature of Attorney

NOTE: If both parents have custody, each must sign.

11. I am 14 years of age or older. I nominate

Name

guardian who lives at

Address City State Zip

Signature of minor

as my

USE NOTE: If a parent is incarcerated and under the jurisdiction of the Michigan Department of Corrections, the petitioner must comply with
MCR 2.004(B).

PC 650i, Petition for Appointment of Limited Guardian of Minor Indian Child (Voluntary Guardianship)

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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/guardianship (2023-03)
Page(s): 2
Fields(s): 74
Average fields per page: 37
Reading Level: Grade 8
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.

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matter was In the matter of (0.33 conf)
undefined__1 was undefined (0.38 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)
minor_currently was 4 The minor is currently (0.31 conf)
unmarried_resides was is unmarried resides in (0.28 conf)
at was at (0.35 conf)
presently_located__1 was and is presently located in 1 (0.38 conf)
presently_located__2 was and is presently located in 2 (0.38 conf)
at_2 was at_2 (0.33 conf)
undefined__2 was undefined_2 (0.39 conf)
action_division_involving was 5 An action within the jurisdiction of the family division of circuit court involving the family or family members of the minor (0.37 conf)
previously_filed was has been previously filed in (0.40 conf)
court_case_number was Court Case Number (0.46 conf)
assigned_judge was was assigned to Judge (0.41 conf)
remains was remains (0.32 conf)
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name_row__1 was NAMERow1 (0.43 conf)
parent_age__1 was ParentAge (0.46 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)
parent_age__2 was ParentAge_2 (0.52 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)
judge was Judge (0.39 conf)
text__1 was Text2 (0.35 conf)
text__2 was Text3 (0.35 conf)
citizen_foreign_country was The minor is a citizen of the following foreign country (0.31 conf)
female was female (0.38 conf)
male was male (0.40 conf)
name_row__3 was NAMERow1_2 (0.30 conf)
street_address__2 was Street address_3 (0.43 conf)
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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)
name_row__4 was NAMERow2_2 (0.30 conf)
street_address__3 was Street address_4 (0.43 conf)
city__3 was City_4 (0.39 conf)
state__3 was State_4 (0.39 conf)
zip__3 was Zip_4 (0.36 conf)
telephone__4 was Telephone no_4 (0.45 conf)
name_row__5 was NAMERow3 (0.43 conf)
street_address__4 was Street address_5 (0.43 conf)
city__4 was City_5 (0.39 conf)
state__4 was State_5 (0.39 conf)
zip__4 was Zip_5 (0.36 conf)
telephone__5 was Telephone no_5 (0.45 conf)
name_representative_person was Name incapacity and representative of the person if any (0.34 conf)
users1_name was Name (1.00 conf)
users1_address_line_one__2 was Address (1.00 conf)
city_township was CityTownship (0.36 conf)
telephone__6 was Telephone no_6 (0.45 conf)
10_other was 10 Other (0.44 conf)
signature_date__1 was Date (1.00 conf)
signature_date__2 was Date_2 (1.00 conf)
signature_date__3 was Date_3 (1.00 conf)
years_age_older_nominate was 11 I am 14 years of age or older I nominate (0.41 conf)
name was Name_2 (0.30 conf)
address was Address_2 (0.35 conf)
signature_date__4 was Date_4 (1.00 conf)
text__3 was Text4 (0.35 conf)
text__4 was Text5 (0.35 conf)
text__5 was Text6 (0.35 conf)
text__6 was Text7 (0.35 conf)
text__7 was Text8 (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 650i, Petition for Appointment of Limited Guardian of Minor Indian Child (Voluntary Guardianship)

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