Free pc670.p65 - Michigan

Approved, SCAO

JIS CODE: MGS

STATE OF MICHIGAN PROBATE COURT COUNTY
CIRCUIT COURT - FAMILY DIVISION

FILE NO. MINOR GUARDIANSHIP SOCIAL HISTORY

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 present address Mother's name Mother's birth date Minor's birth date City Father's name Minor's social security no. State Father's birth date Zip

Father's name on minor's birth certificate Paternity established through court proceedings If yes, specify court and county where paternity was established

Yes Yes Child Child Child Child

No No Father Father Father Father Mother Mother Mother Mother

Yes Yes

No No

Circuit

Probate
If yes, specify county of divorce

County County

Minor's parents married to each other

Minor's parents divorced from each other

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

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

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)

Proposed Guardian Information:
Name of proposed guardian (including any prior names) Present address Relationship to minor Guardianship of any other minor Occupation Home phone no. City Work phone no. Birth date State Cell phone no. Driver license no. Zip Social security no. Length of time at this address

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

If yes, give name and file numbers of each minor child 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 the Department of Human Services 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 (11/05)

MINOR GUARDIANSHIP SOCIAL HISTORY

MCR 5.404(A)

Proposed Guardian Questionnaire: (the proposed guardian must complete all items below) 1. Describe the reasons for the guardianship.

2. Do the parents agree with this guardianship?

Yes

No

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