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USE NOTE: File this form with the petition for appointment of guardian. This information is confidential and will not be placed in the public court file.

Parent and Minor Child Information:
Name of minor

Minor’s birth date

Last 4 digits of Minor’s SSN

Minor’s present address City State Zip

Parent’s name

Parent’s birth date

Parent’s name

Parent’s birth date

Father’s name on minor’s birth certificate

Paternity established through court proceedings

If yes, specify court and county where paternity was established

Yes

Circuit

Probate

County

Minor’s parents married to each other

Minor’s parents divorced from each other

If yes, specify county of divorce

Check any of the following that are true about the child or parent(s) and describe below (include the name of any case worker)

Yes

County

Victim of domestic violence
Had contact with the protective services unit of MDHHS
Experienced a substance abuse problem
Experienced a mental health problem

Yes

Child
Child
Child
Child

Parent(s):

Name of school child attends (specify if home schooled)

Describe child’s school attendance, behavior, and grades

Describe child’s relationship and extent of contact with parent(s)

If the child is a member of an Indian tribe, or is eligible for membership in an Indian tribe and is a biological child of a member of an Indian tribe, list the child’s
tribal affiliation.

Proposed Guardian Information:
Name of proposed guardian (including any prior names)

Birth date

Driver’s license no.

Last 4 digits of SSN

Present address City State Zip

Length of time at this address

Relationship to minor

Home phone no. Work phone no.

Cell phone no.

Best number to call between 8:00 a.m. and 5:00 p.m.

Guardianship of any other minor

If yes, give name and file numbers of each minor child

Occupation Employer’s name and telephone no. Length of time with this employer

Check any of the following that are true about the proposed guardian and describe below (include the name of any case worker)

Victim of domestic violence
Had contact with the protective services unit of MDHHS
Experienced a substance abuse problem
Experienced a mental health problem

Specify the date, place, and nature of any offense, other than a minor traffic violation, for which you were convicted; check if none

None

PC 670 (12/17) MINOR GUARDIANSHIP SOCIAL HISTORYMCR 5.404(A)(4)Approved, SCAO JIS CODE: MGSSTATE OF MICHIGANPROBATE COURTCOUNTY OFMINOR GUARDIANSHIPSOCIAL HISTORYFILE NO.Proposed Guardian Questionnaire: (the proposed guardian must complete all items below)

1. Describe the reasons for the guardianship.

File No.

2. Do the parents agree with this guardianship?

Yes

If no, explain.

3. Describe the parents’ visiting schedule with the child after you are the guardian. If there is no understanding about this, check

none.

4. Describe any physical and/or mental limitations you have that would affect your ability to raise this child. If there are none,
check

none.

5. Describe the type (visits, telephone calls, etc.) and frequency of contact (daily, weekly, etc.) you have had with the minor in

the past.

6. Explain how you propose to handle the additional financial burden of this guardianship. List annual income of the household
and the sources of that income.

7. Describe the sleeping space you have in your home for this child.

8. Indicate how many other children live in your home.

9. Describe the methods of discipline you would use to control this child.

10. Provide the full name and date of birth of every adult living in the home.

11. List two people the court may contact for references. Provide their names, addresses, and telephone numbers.

12. Specify any other information you believe would be helpful to the court.

Date

Signature

Minor Guardianship Social History (12/17)

PC 670, Minor Guardianship Social History

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): 77
Average fields per page: 38
Reading Level: Grade 7
LIST Grouping(s): ES-03-00-00-00, FA-00-00-00-00.

Use our Rate My PDF tool to learn more. Go beyond the above insights and learn more about this or any pdf form at RateMyPDF.com, includes: counts of difficult words used, passive voice decetion, and suggestions for how to make the form more usable.

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_n_cour_count was STATE OF MICHIGAN PROBATE COURT COUNTY OF (0.67 conf)
name_minor was Name of minor (0.40 conf)
minors_birth_date was Minors birth date (0.37 conf)
last_digits_minors_ssn was Last 4 digits of Minors SSN (0.35 conf)
present_address_city_state was Minors present address City State Zip (0.37 conf)
parents_name__1 was Parents name (0.41 conf)
parents_birth_date__1 was Parents birth date (0.43 conf)
parents_name__2 was Parents name_2 (0.40 conf)
parents_birth_date__2 was Parents birth date_2 (0.39 conf)
paternity_court_proceedings was Paternity established through court proceedings (0.51 conf)
yes__1 was Yes_2 (0.39 conf)
no_2 was No_2 (0.39 conf)
circuit was Circuit (0.33 conf)
probate was Probate (0.47 conf)
minors_parents_divorced was Minors parents divorced from each other (0.32 conf)
yes__2 was Yes_4 (0.39 conf)
no_4 was No_4 (0.39 conf)
child__1 was Child (0.38 conf)
child__2 was Child_2 (0.40 conf)
child__3 was Child_3 (0.40 conf)
child__4 was Child_4 (0.40 conf)
parents__1 was Parents (0.37 conf)
parents__2 was Parents_2 (0.34 conf)
parents__3 was Parents_3 (0.34 conf)
parents__4 was Parents_4 (0.34 conf)
name_school_child_specify was Name of school child attends specify if home schooled (0.38 conf)
school_behavior_grades was Describe childs school attendance behavior and grades (0.32 conf)
describe_childs_relationship_extent_contact_parents was Describe childs relationship and extent of contact with parents (0.31 conf)
child_tribe_tribal was If the child is a member of an Indian tribe or is eligible for membership in an Indian tribe and is a biological child of a member of an Indian tribe list the childs tribal affiliation (0.25 conf)
name_including_prior was Name of proposed guardian including any prior names (0.41 conf)
birth_date was Birth date (0.43 conf)
drivers_license was Drivers license no (0.53 conf)
last_digits_ssn was Last 4 digits of SSN (0.34 conf)
present_address_city_state_zip was Present address City State Zip (0.37 conf)
length_time_address was Length of time at this address (0.36 conf)
relationship_minor was Relationship to minor (0.44 conf)
home_phone was Home phone no (0.44 conf)
work_phone was Work phone no (0.38 conf)
cell_phone was Cell phone no (0.43 conf)
best_number_call_pm was Best number to call between 800 am and 500 pm (0.36 conf)
guardianship_minor was Guardianship of any other minor (0.41 conf)
yes_give_name_minor_child was If yes give name and file numbers of each minor child (0.37 conf)
victim_domestic_violence was Victim of domestic violence (0.35 conf)
contact_services_unit was Had contact with the protective services unit of MDHHS_2 (0.33 conf)
substance_abuse_problem was Experienced a substance abuse problem (0.39 conf)
mental_health_problem was Experienced a mental health problem (0.36 conf)
specify_minor_none was Specify the date place and nature of any offense other than a minor traffic violation for which you were convicted check if none None (0.34 conf)
undefined was undefined_4 (0.39 conf)
check_box__1 was Check Box1 (0.52 conf)
check_box__2 was Check Box2 (0.37 conf)
check_box__3 was Check Box3 (0.37 conf)
check_box__4 was Check Box4 (0.37 conf)
check_box__5 was Check Box5 (0.37 conf)
check_box__6 was Check Box6 (0.37 conf)
check_box__7 was Check Box7 (0.37 conf)
check_box__8 was Check Box8 (0.37 conf)
text__1 was Text9 (0.35 conf)
occupation_employers_employer was Occupation Employers name and telephone no Length of time with this employer (0.42 conf)
tex__1 was TEXT 100 (0.40 conf)
tex__2 was TEXT 200 (0.39 conf)
none__1 was none (0.32 conf)
none__2 was none_2 (0.38 conf)
signature_date was Date (1.00 conf)
text__2 was Text10 (0.35 conf)
check_box__9 was Check Box11 (0.37 conf)
check_box__10 was Check Box12 (0.37 conf)
text__3 was Text13 (0.35 conf)
text__4 was Text14 (0.35 conf)
text__5 was Text15 (0.35 conf)
text__6 was Text16 (0.35 conf)
text__7 was Text17 (0.35 conf)
text__8 was Text18 (0.35 conf)
text__9 was Text19 (0.35 conf)
text__10 was Text20 (0.35 conf)
text__11 was Text21 (0.35 conf)
text__12 was Text22 (0.35 conf)
text__13 was Text23 (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 670, Minor Guardianship Social History

About This Form:

Identified Data Fields:

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