Approved, SCAO JIS CODE: OAG STATE OF MICHIGAN PROBATE COURT COUNTY CIRCUIT COURT - FAMILY DIVISION ORDER APPOINTING GUARDIAN FOR INDIVIDUAL WITH A DEVELOPMENTAL DISABILITY FILE NO. , an individual with a developmental disability In the matter of 1. Date of hearing: Judge: Bar no. 2. Findings of fact are more fully stated on the record regarding the individual's nature and extent of general intellectual functioning, extent of impairment of adaptive behavior, capacity to manage his/her estate and financial affairs, and capacity to care for self by making and communicating responsible decisions concerning his or her person. THE COURT FINDS: 3. Notice of hearing was given to or waived by all interested parties. 4. a. The individual was present at the hearing. b. The individual was not present at the hearing. His/her presence was excused upon showing by testimony and affidavit of a psychologist, physical physician, that the individual's attendance would subject him/her to serious emotional harm. 5. Testimony was given by the person who prepared the report or person who performed an evaluation serving, in part, as the basis for the report. with 6. Upon the presentation of clear and convincing evidence and without the verdict of a jury, the individual is an individual with a developmental disability and requires guardianship services. totally person 7. The individual named above is partially without capacity to care for his/her estate as to the following necessary tasks, responsibilities, or judgments but is otherwise legally competent and has the capacity to perform in other areas. 8. The most appropriate and the least restrictive living arrangement suited to the individual's condition is . . The individual presently resides in the following facility: 9. A reasonable effort was made to question the individual and he/she indicated no preference as to who should be appointed guardian. that he/she preferred and Name (type or print) to serve as guardian Name (type or print) as standby guardian. (PLEASE SEE OTHER SIDE) Do not write below this line - For court use only MCL 330.1617, MCL 330.1618, MCL 330.1620, MCL 330.1623, MCL 330.1626 PC 660 (9/08) ORDER APPOINTING GUARDIAN FOR INDIVIDUAL WITH DEVELOPMENTAL DISABILITY American LegalNet, Inc. www.FormsWorkflow.com 10. There is no qualified, suitable individual or agency willing to act as guardian and the appointment of an agency directly providing services to the individual is necessary at present. 11. 12. A reasonable effort was made to orally inform the individual of his/her right to request the guardianship to be dismissed or modified at any time. A written notice of these rights was also served on him/her. Other: IT IS ORDERED: 13. The petition is granted. denied on the merits. 14. dismissed/withdrawn. , whose address and telephone number are Name (type or print) , Address City State Zip Telephone no. is appointed a. plenary guardian of the and shall qualify by filing b. partial guardian of the and shall qualify by filing individual estate until further order of the court an acceptance of appointment. a bond in the amount of $ individual estate for the term of . years an acceptance of appointment. a bond in the amount of $ , and shall have only the following powers: The individual retains all legal and civil rights except those which have been specifically granted to the partial guardian. After qualification, the guardian shall comply with all relevant requirements under the law. 15. The guardian is authorized to execute an application to admit the individual named above to . Name of facility 16. , whose address and telephone number are Name (type or print) Address City State Zip Telephone no. , is appointed standby guardian. In case of death, incapacity, or resignation of the initially-appointed guardian or an emergency situation during the absence and unavailability of the initially appointed guardian, the standby guardian shall file an acceptance of appointment bond in the amount of $ and shall assume the powers and duties of the initially-appointed guardian. Date Attorney name (type or print) Address Judge Bar no. City State Zip Telephone no. American LegalNet, Inc. www.FormsWorkflow.com