Free pc654.p65 - Michigan

Approved, SCAO

JIS CODE: AGM

STATE OF MICHIGAN PROBATE COURT COUNTY
CIRCUIT COURT - FAMILY DIVISION

FILE NO. ANNUAL REPORT OF GUARDIAN ON CONDITION OF MINOR

This report should be completed annually by the guardian, or more often if directed by the court. In the matter of 1. I,
Name (type or print) Date

, minor , am the guardian of the above named minor and my annual to
Date

report for the period

is as follows:

2. Present age of the minor: 3. Living Arrangement a. Current address and telephone number of the minor : b. The minor's residence is: guardian's home relative's home:

Minor's date of birth:

Relationship

other: . If moved within the past year, state

c. The minor has been in the present residence since Date the changes and the reasons for change:

d. I rate the minor's living arrangement as e. I believe the minor is

excellent.

average.

below average. unhappy with the living situation.

content with the living situation.

f. I recommend a more suitable living arrangement for the minor as follows:

4. Physical Health a. The minor's current physical condition is excellent. b. During the past year the minor's physical condition has remained about the same. improved.
Explain Explain

good.

fair.

poor.

worsened.

c. During the past year the minor received the following medical treatment (include check-ups and optical and dental work): Date Ailment Type of Treatment Doctor's Name

(PLEASE SEE OTHER SIDE)
Do not write below this line - For court use only

PC 654 (1/06)

ANNUAL REPORT OF GUARDIAN ON CONDITION OF MINOR

MCL 700.5215(f)), MCR 5.409(A)

5. Education a. The minor regularly attends school at and is in grade . b. The minor attends alternative education at and is in grade . c. The minor does not attend school because 6. Activities of Minor a. The minor's social activities are:

.

b. The minor participates in the following sports: c. During the past year the minor has been in counseling with at d. During the past year the minor received in-patient services at . 7. Parenting time between the minor and parents was as follows: a. Father Father's current address: b. Mother Mother's current address: c. Comments about parenting time: .

8. Parents complied with the

court structured plan

limited guardianship placement plan

as follows:

Changes should be made to the plan as follows:

9. The guardianship

should

should not

be continued because:

10. I am am not willing to continue to serve as guardian. 11. As guardian, I have been ordered by the court to file an annual account which is attached.
Date Signature of guardian Address City, state, zip Telephone no.