STATE OF MICHIGAN

CASE NO. and JUDGE

PROBATE COURT
COUNTY

ORDER FOR APPOINTMENT OF 
OUT-OF-STATE GUARDIAN OF 
LEGALLY INCAPACITATED INDIVIDUAL

Court address              

 

 

 

Court telephone no.

In the matter of 

First, middle, and last name

                                 

 
Court ORI*

*Court ORI is to be completed by the court.

Date of birth

Race

Sex Address of incapacitated individual where now found

ORDER APPOINTING GUARDIAN

1.	An	application	for	appointment	of	a	guardian	of	an	incapacitated	individual	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.

 is appointed temporary guardian of

 , a legally incapacitated individual, in this state.

IT IS ORDERED:

Name of guardian (type or print)

Name of individual (type or print)

2. 

   

 
 

 
 
 

 

 

 

 

 

Judge/Magistrate/Referee/Deputy clerk signature and date

 

 
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 legally incapacitated individual.

NOTICE TO INTERESTED PERSONS

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 685o, Rev. 5/21
MCL 700.1105(a), MCL 700.5301a, MCR 5.107, MCR 5.125(C)(23)
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JIS Code: OOGPetitioner’s name, address and telephone no.Petitioner’s attorney, bar no., address, and telephone no.