In the matter of 

First and last name(s), alias(es)

1. 

 After hearing before: 

 

 Upon review by: 

Judge/Referee                                                                                                  

THE COURT FINDS:

2. On 
 
  best interest of the child to appoint a juvenile guardian over the child.

 , in case number 
 

 , the court determined it to be in the

3. 

 a. The parental rights over the child have not been terminated.

 
 
 

 b. The parental rights over the child were terminated on 

 . The written consent of the

        Michigan Children’s Institute superintendent to the juvenile guardianship  
 is not required because the child was not committed to MCI.   
       

 

 has been filed.

 is not required under MCR 3.979(A)(3)(c).

 

4. Placement of the child with a juvenile guardian continues to be necessary and appropriate.

5. The results of the required criminal record check and central registry have been submitted to the court. The home study 
  of the juvenile guardian was submitted to the court in accordance with MCR 3.979(A)(1)(b).

 6. There will be sufficient assets under the control of the juvenile guardian to require a conservatorship.

IT IS ORDERED:

Name (type or print)

7. 

 

Address                                                                              City                                                      State                  Zip                           Telephone no.

is appointed juvenile guardian of the child named above, and an acceptance of appointment shall be filed. Upon 

 
  acceptance of the appointment, the juvenile guardian shall comply with all relevant requirements of MCL 700.5215 and 
  MCR 3.979(E).

 8. Other: (Include provisions such as parenting time or child support. When item 6 is checked, include a provision requiring the juvenile guardian to
    petition the probate court for a conservator.) 

 

 , whose address and telephone number are

 ,

Recommended by: Referee signature and date

                     

 
NOTE: A separate order must be entered for each child.
Approved, SCAO
Form JC 91, Rev. 9/20
MCL 712A.19a, MCL 712A.19c, MCR 3.979
Page 1 of 1

Judge signature and date

STATE OF MICHIGANJUDICIAL CIRCUIT - FAMILY DIVISIONCOUNTYORDER APPOINTING JUVENILE GUARDIANCASE NO.PETITION NO.JUDGECourt addressCourt telephone no.JIS Code: OJG