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.