In the matter of 

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

TO:

Name and address

Juvenile guardian’s telephone no.

1. You have been appointed as juvenile guardian of the child named above.

2. Having filed an acceptance of appointment, you have the care, custody, and control of the child, together with all 
  authority and responsibilities granted and imposed by MCL 700.5215 and MCR 3.979.

3. Other restrictions or limitations: 
 
 

 You shall not move the child’s residence from the State of Michigan without a court order.
 Other (specify): 

 

                     

Judge signature and date

I certify that I have compared this copy with the original on file and that it is a correct copy of the whole of such original, and 
on this date, these letters are in full force and effect.

 

                     

Clerk/Deputy clerk signature and date

You are required to file with this court written reports as follows:

NOTICE OF REPORTING DUTIES

CHANGE OF ADDRESS: You are required to keep the court and interested persons informed in writing within 7 days of 
  any change in your address.
ANNUAL REPORT: Your annual report on the condition of the child is due on 
  each year. In addition, you must serve the report on the child and interested persons as specified in the Michigan Court 
  Rules and file proof of service with the court.
DEATH OF MINOR: If a minor dies during the guardianship, you must file written notice with the court within 14 days of the
  minor’s date of death.

 of 

 

The above provisions are reporting duties only and are not the only duties required of you. See MCL 700.5215 and 
MCR 3.979(B) for the authority and duties of a juvenile guardian.
Approved, SCAO
Form JC 93, Rev. 12/22
MCR 3.979(B)(2)
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STATE OF MICHIGANJUDICIAL CIRCUIT - FAMILY DIVISIONCOUNTYLETTERS OF JUVENILE GUARDIANSHIPCASE NO.PETITION NO.JUDGECourt addressCourt telephone no.JIS Code: LOG