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STATE OF MICHIGAN

PROBATE COURT
COUNTY

REPORT OF GUARDIAN ON
CONDITION OF INDIVIDUAL WITH
DEVELOPMENTAL DISABILITY

CASE NO. and JUDGE

Court address

Court telephone no.

This report should be completed annually by the guardian or more often if directed by the court.

In the matter of

First, middle, and last name of individual with a developmental disability

, am the guardian of the individual named above, and I report

Date

1. I,

Name (type or print)

for the period

Date

2. Present age of the individual:

Check here if this is a new address

3. The current address and telephone number of the individual are:

4. The individual's present living arrangement is:

own home
hospital or medical center
community placement home

relative's home
guardian's home
other:

Relationship

5. The individual has been in the present residence since
every residence where the individual has lived during this reporting period and the length of stay at each residence are

. Descriptions and addresses of

. I rate the individual's present living arrangements as

excellent.

average.

below average.

7. I believe the individual is

content with the living situation.

unhappy with the living situation. I recommend a

more suitable residence as follows:

Describe

8. The individual's mental condition has

remained about the same.

improved.

deteriorated.

Describe the changes

9. The individual's physical health has

remained about the same.

improved.

deteriorated.

Describe the changes

Explain if below average

as follows:

Approved, SCAO
Form PC 663, Rev. 12/22
MCL 330.1631, MCR 5.409(A)
Page 1 of 3

PCS Code: CDPTCS Code: RGDReport of Guardian on Condition of Individual with Developmental Disability
Page 2 of 3

(12/22)

Case No.

10. The individual’s social condition has

remained about the same.

improved.

deteriorated.

Describe the changes

11. The individual has received the following services:
vocational.

educational.

medical.

other professional services.

12. My visits with and activities on behalf of the individual were:

13. I believe the individual has the following needs:

14. I have the following questions concerning the individual or my responsibilities:

15. Other information requested by the court or necessary in the opinion of the guardian is as follows:

16. The guardianship

should

should not

be continued because:

am not

willing to continue to serve as guardian.

NOTE: If you no longer wish to serve, you must file a Petition to Terminate/Modify Guardian for Developmentally
Disabled Individual (PC 677).

18. As guardian, I have been ordered by the court to file an annual account, which is attached.

19. Comments:

Signature of guardian

Signature of co-guardian (if applicable)

Date

Address

City, state, zip Telephone no.

Check here if this is a new address

Describe

17. I

Date

Address

Report of Guardian on Condition of Individual with Developmental Disability
Page 3 of 3

(12/22)

Case No.

STATEMENT BY STANDBY GUARDIAN

I am the appointed standby guardian and am willing to continue to serve in the event the guardian dies, becomes unable
to serve, or resigns from the guardianship.

Date

Address

Check here if this is a new address

Signature of standby guardian

City, state, zip Telephone no.

PC 663, Report of Guardian on Condition of Individual with Developmental Disability

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): 3
Fields(s): 84
Average fields per page: 28
Reading Level: Grade 10
LIST Grouping(s): Unknown

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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_michiga_n_probat_cour_county was STATE OF MICHIGAN PROBATE COURT COUNTY (0.62 conf)
report_completed_often was This report should be completed annually by the guardian or more often if directed by the court (0.35 conf)
first_last_name_individual was First middle and last name of individual (0.35 conf)
name_type_print was Name type or print (0.45 conf)
signature_date__1 was Date_2 (1.00 conf)
present_age_individual was 2 Present age of the individual (0.32 conf)
current_number_individual was 3 The current address and telephone number of the individual are (0.37 conf)
undefined__1 was undefined (0.38 conf)
check_new_address__1 was Check here if this is a new address (0.32 conf)
relationship was Relationship (0.39 conf)
home was own home (0.47 conf)
hospital_medical_center was hospital or medical center (0.41 conf)
community_placement_home was community placement home (0.35 conf)
relatives_home was relatives home (0.49 conf)
guardians_home was guardians home (0.45 conf)
other was other (0.43 conf)
undefined__2 was undefined_2 (0.39 conf)
every_individual_period was every residence where the individual has lived during this reporting period and the length of stay at each residence are (0.36 conf)
follows__1 was as follows 1 (0.46 conf)
follows__2 was as follows 2 (0.46 conf)
excellent was excellent (0.32 conf)
average__1 was average (0.32 conf)
average__2 was below average (0.35 conf)
explain_average was Explain if below average (0.36 conf)
content_living_situation was content with the living situation (0.30 conf)
unhappy_living_situation was unhappy with the living situation I recommend a (0.36 conf)
describe__1 was Describe (0.40 conf)
remained__1 was remained about the same (0.37 conf)
improved__1 was improved (0.38 conf)
deteriorated__1 was deteriorated (0.31 conf)
describe_changes__1 was Describe the changes (0.34 conf)
remained__2 was remained about the same_2 (0.34 conf)
improved__2 was improved_2 (0.31 conf)
deteriorated__2 was deteriorated_2 (0.39 conf)
describe_changes__2 was Describe the changes_2 (0.40 conf)
judge was Judge (0.39 conf)
text__1 was Text2 (0.35 conf)
signature_date__2 was Date (1.00 conf)
remained__3 was remained about the same_3 (0.34 conf)
improved__3 was improved_3 (0.31 conf)
deteriorated__3 was deteriorated_3 (0.39 conf)
individuals_social_condition was 10 The individuals social condition has (0.33 conf)
medical was medical (0.41 conf)
educational was educational (0.38 conf)
vocational was vocational (0.30 conf)
professional_services was other professional services (0.42 conf)
describe__2 was Describe_2 (0.45 conf)
undefined__3 was undefined_3 (0.39 conf)
visits_activities_individual was 12 My visits with and activities on behalf of the individual were (0.28 conf)
undefined__4 was undefined_4 (0.39 conf)
individual_following_needs__1 was 13 I believe the individual has the following needs 1 (0.33 conf)
individual_following_needs__2 was 13 I believe the individual has the following needs 2 (0.33 conf)
undefined__5 was undefined_5 (0.39 conf)
questions_concerning__1 was 14 I have the following questions concerning the individual or my responsibilities 1 (0.39 conf)
questions_concerning__2 was 14 I have the following questions concerning the individual or my responsibilities 2 (0.39 conf)
undefined__6 was undefined_6 (0.39 conf)
necessary_opinion_follows__1 was 15 Other information requested by the court or necessary in the opinion of the guardian is as follows 1 (0.44 conf)
necessary_opinion_follows__2 was 15 Other information requested by the court or necessary in the opinion of the guardian is as follows 2 (0.44 conf)
continued was be continued because (0.39 conf)
guardianship was 16 The guardianship 1 (0.40 conf)
ordered_annual_account was 17 As guardian I have been ordered by the court to file an annual account which is attached (0.37 conf)
undefined__7 was undefined_7 (0.39 conf)
signature_date__3 was Date_3 (1.00 conf)
signature_date__4 was Date_4 (1.00 conf)
users1_address_line_one was Address (1.00 conf)
address__1 was Address_2 (0.35 conf)
check_new_address__2 was Check here if this is a new address_2 (0.33 conf)
check_new_address__3 was Check here if this is a new address_3 (0.33 conf)
text__2 was Text3 (0.35 conf)
text__3 was Text4 (0.35 conf)
text__4 was Text5 (0.35 conf)
text__5 was Text6 (0.35 conf)
text__6 was Text7 (0.35 conf)
text__7 was Text8 (0.35 conf)
signature_date__5 was date100 (1.00 conf)
should was should (0.36 conf)
should_not was should not (0.43 conf)
17._am was 17. am (0.45 conf)
17._am_not was 17. am not (0.48 conf)
signature_date__6 was Date_5 (1.00 conf)
address__2 was Address_3 (0.35 conf)
check_new_address__4 was Check here if this is a new address_4 (0.33 conf)
users1_address_line_two was City state zip (1.00 conf)
telephone was Telephone no (0.44 conf)
text__8 was Text9 (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 663, Report of Guardian on Condition of Individual with Developmental Disability

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