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Here is the text we could read:

STATE OF MICHIGAN

CASE NO. and JUDGE

PROBATE COURT
COUNTY

PETITION FOR APPOINTMENT OF
LIMITED GUARDIAN OF MINOR

Court address

Court telephone no.

In the matter of

First, middle, and last name

Address City/Township State Zip

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

2. The minor is currently

, is

female,

male, is unmarried, resides in

Age

County

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:

3. The persons interested in this proceeding are:

NAME

RELATIONSHIP

ADDRESS AND TELEPHONE NUMBER

Street address

City

Street address

Parent/Age

Conservator

Guardian

State

Zip

Telephone no.

State

Zip

Telephone no.

State

Zip

Telephone no.

State

Zip

Telephone no.

Person with care/
custody of minor*

State

Zip

Telephone no.

None of these persons are under any legal incapacity except

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

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

Approved, SCAO
Form PC 650, Rev. 5/21
MCL 700.5205, MCR 5.125(C)(20), MCR 5.404
Page 1 of 2

JIS Code: LGMPetitioner’s name, address and telephone no.Petitioner’s attorney, bar no., address, and telephone no.Petition for Appointment of Limited Guardian of Minor
Page 2 of 2

(5/21)

Case No.

The minor is not an Indian child as defined in MCR 3.002(12).
It is unknown whether the minor is an Indian child as defined in MCR 3.002(12).

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

Court, Case Number

, and

remains

is no longer pending.

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

7. 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

10. I CONSENT TO THE SUSPENSION OF MY PARENTAL RIGHTS.

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

Date

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

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

Name

who lives at

Address City State Zip

Signature of minor

as my guardian

Attorney signature

Address

Attorney name (type or print) Bar no.

City, state, zip Telephone no.

I REQUEST:

Name

9. Other:

Date

PC 650, Petition for Appointment of Limited Guardian of Minor

This info page is part of the LIT Lab's Form Explorer project. It is not associated with the Michigan state courts. To learn more about the project, check out our about page.

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): 79
Average fields per page: 39
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.

stat_e_f_michiga_n_probat_cour_county was STATE OF MICHIGAN PROBATE COURT COUNTY (0.62 conf)
court_address was Court address (0.42 conf)
first_middle_last_name was First middle and last name (0.37 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)
county__1 was County (0.39 conf)
users1_address_line_one__1 was Address (1.00 conf)
county__2 was County_2 (0.37 conf)
address_different was Address only if different than above (0.38 conf)
city_township__1 was CityTownship_2 (0.33 conf)
undefined__1 was undefined (0.38 conf)
name_row__1 was NAMERow1 (0.43 conf)
users1_address_line_one__2 was Street address (1.00 conf)
users1_address_city was City (1.00 conf)
state__1 was State_3 (0.39 conf)
telephone__1 was Telephone no (0.44 conf)
name_row__2 was NAMERow2 (0.43 conf)
street_address__1 was Street address_2 (0.43 conf)
city__1 was City_2 (0.39 conf)
state__2 was State_4 (0.39 conf)
zip__1 was Zip_4 (0.36 conf)
telephone__2 was Telephone no_2 (0.45 conf)
name_row__3 was NAMERow3 (0.43 conf)
street_address__2 was Street address_3 (0.43 conf)
city__2 was City_3 (0.39 conf)
state__3 was State_5 (0.39 conf)
zip__2 was Zip_5 (0.36 conf)
telephone__3 was Telephone no_3 (0.45 conf)
name_row__4 was NAMERow4 (0.43 conf)
street_address__3 was Street address_4 (0.43 conf)
city__3 was City_4 (0.39 conf)
state__4 was State_6 (0.39 conf)
zip__3 was Zip_6 (0.36 conf)
telephone__4 was Telephone no_4 (0.45 conf)
name_row__5 was NAMERow5 (0.43 conf)
street_address__4 was Street address_5 (0.43 conf)
city__4 was City_5 (0.39 conf)
state__5 was State_7 (0.39 conf)
zip__4 was Zip_7 (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)
judge was Judge (0.39 conf)
text__1 was Text2 (0.35 conf)
female was female (0.38 conf)
citizen_foreign_country was The minor is a citizen of the following foreign country (0.31 conf)
male was male (0.40 conf)
zip__5 was Zip_3 (0.36 conf)
parentage__1 was parentage2 (0.35 conf)
parentage__2 was parentage1 (0.35 conf)
current_age was current age (0.42 conf)
minor_indian_child_mc_r was The minor is not an Indian child as defined in MCR 300212 (0.36 conf)
unknown_whether_minor_child_r was It is unknown whether the minor is an Indian child as defined in MCR 300212 (0.37 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)
court_case_number was Court Case Number (0.46 conf)
undefined__2 was undefined_2 (0.39 conf)
and was and (0.41 conf)
remains was remains (0.32 conf)
longer was is no longer (0.37 conf)
users1_name was Name (1.00 conf)
address__1 was Address_2 (0.35 conf)
city_township__2 was CityTownship_3 (0.33 conf)
telephone__6 was Telephone no_6 (0.45 conf)
9_other was 9 Other (0.44 conf)
signature_date__1 was Date (1.00 conf)
signature_date__2 was Date_2 (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__2 was Address_3 (0.35 conf)
signature_date__3 was Date_3 (1.00 conf)
attorney_name_type_print was Attorney name type or print (0.50 conf)
bar was Bar no (0.41 conf)
address__3 was Address_4 (0.35 conf)
users1_address_line_two was City state zip (1.00 conf)
telephone__7 was Telephone no_7 (0.45 conf)
text__2 was Text3 (0.35 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)

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

PC 650, Petition for Appointment of Limited Guardian of Minor

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Identified Data Fields:

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