Approved, SCAO
JIS CODE: CLC/WOA
STATE OF MICHIGAN PROBATE COURT COUNTY
CIRCUIT COURT - FAMILY DIVISION
FILE NO. CERTIFICATE OF LEGAL COUNSEL / WAIVER OF ATTENDANCE
In the matter of
CERTIFICATE OF LEGAL COUNSEL 1. I have been appointed by the court as legal counsel for the individual named above. 2. A hearing on the petition for admission/hospitalization/assisted outpatient treatment has been set as follows: Date: Time: Location: Judge: 3. I certify that I personally have seen and consulted with the individual at least 24 hours before the time set for the hearing.
Date
Signature of attorney Attorney name (type or print) Address City, state, zip
Bar no.
Telephone no.
WAIVER OF ATTENDANCE I understand that it is my right to be present at the hearing on the petition for admission/hospitalization/assisted outpatient treatment set for the date stated above but I waive that right.
Date
Signature of the individual named above
Witness:
Signature of legal counsel
Do not write below this line - For court use only
PCM 223 (9/07)
CERTIFICATE OF LEGAL COUNSEL / WAIVER OF ATTENDANCE
MCL 330.1454(1), MCL 330.1455(1)