ACCEPTANCE OF APPOINTMENT AND
REPORT OF GUARDIAN AD LITEM

JIS CODE:  AGL

FILE NO.

1. I have been appointed by the court as guardian ad litem for

Name

    ,

Approved, SCAO

STATE OF MICHIGAN

PROBATE COURT
COUNTY
CIRCUIT COURT - FAMILY DIVISION

In the matter of

and I accept this appointment.

2. I report to the court as follows:

3. I recommend:

Date

Signature

Name (type or print)

Address

City, state, zip

Telephone no.

NOTE:  See other side for partial duties of the guardian ad litem in conservatorship.

Do not write below this line - For court use only

PC 643  (9/07)   ACCEPTANCE OF APPOINTMENT AND REPORT OF GUARDIAN AD LITEM

MCL 700.1403(d), MCL 700.5406,
MCR 5.121

NOTICE OF PARTIAL DUTIES OF GUARDIAN AD LITEM IN CONSERVATORSHIP:

A guardian ad litem appointed under MCL 700.5406 who meets with, examines, or evaluates an individual who is the subject of

a petition in a protective proceeding shall do all of the following:

• Consider whether there is an appropriate alternative to a conservatorship.

•

If a conservatorship is appropriate, consider the desirability of limiting the scope and duration of the conservator's authority.

• Report to the court on the basis of the required considerations stated above.

Please note that these are not the only duties required of a guardian ad litem.



Acceptance of Appointment and Report of Guardian Ad Litem

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About This Form:

• Sourced from www.courts.michigan.gov/conservatorship-protected-individuals (2023-03)
• Page(s): 2
• Fields(s): 11
• Average fields per page: 5
• Reading Level: Grade 8
• LIST Grouping(s): CO-07-00-00-00, CO-00-00-00-00.

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