STATE OF MICHIGAN PROBATE COURT OAKLAND COUNTY In the matter of FILE NO. AFFIDAVIT AND ORDER EXCUSING RESPONDENT'S PRESENCE , an individual with a developmental disability AFFIDAVIT 1. 2. 3. I am a licensed physician psychologist Date in the State of Michigan. . I examined the above named respondent on It is my professional opinion that attendance at any and all proceedings in this matter would subject the respondent to serious risk of physical or emotional harm for the reason that: 4. I request that the respondent's presence be excused. Affiant Signature Subscribed and sworn to before me on Date , Signature: County, Michigan. My commission expires: Date Deputy clerk/Register/Notary public ORDER IT IS ORDERED that: The Request to Excuse Respondent's Presence is: 1. 2. Granted Denied Date Judge Bar no. Do not write below this line ­ For court use only FILED Deputy Register of Probate PEMH 1100 (4/06) AFFIDAVIT AND ORDER EXCUSING RESPONDENT'S PRESENCE 20 MCL 330.1617(4) American LegalNet, Inc. www.FormsWorkflow.com