STATE OF MICHIGAN

CASE NO. and JUDGE

PROBATE COURT
COUNTY

ORDER FOR APPOINTMENT OF
OUT-OF-STATE GUARDIAN OF MINOR

Court address              

 

 

 

Court telephone no.

In the matter of 

First, middle, and last name

Applicant’s name, address, and telephone no.

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

1. An application for appointment of a guardian of a minor was filed in this court along with an authenticated copy of the    
  guardian’s letters of appointment in the other state and an acceptance of appointment in this state.

ORDER APPOINTING GUARDIAN

IT IS ORDERED:

2. 

 

Name of guardian (type or print)

Name of minor (type or print)

 is appointed temporary guardian of

 , a minor in this state.

Judge signature and date

NOTICE TO INTERESTED PERSONS

Unless an objection to the above appointment is filed with the court within 28 days of the date of the order appointing, the 
temporary guardian shall be appointed full guardian of the minor.

NOTE TO APPLICANT: Within 14 days of your appointment as the temporary guardian, you must send, by first-class mail, 
a copy of this application, order, and notice to all interested persons and file proof of service with this court.

Approved, SCAO
Form PC 684o, Rev. 5/21
MCL 700.5202a, MCR 5.107, MCR 5.125(C)(20)
Page 1 of 1

JIS Code: OOM

PC 684o, Order for Appointment of Out-of-State Guardian of Minor

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About This Form:

• Sourced from www.courts.michigan.gov/conservatorship-protected-individuals (2023-03)
• Page(s): 1
• Fields(s): 10
• Average fields per page: 10
• Reading Level: Grade 8
• LIST Grouping(s): CO-07-00-00-00, CO-00-00-00-00.

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