en-USIn the matter of First, middle, and last name en-US Last four digits of SSN en-US , a minor 1. � I am interested in this matter and make this petition as custodial parent of the minor. � 2. � An action within the jurisdiction of the family division of circuit court involving the family or family members of the minor � � has been previously filed in en-US Court, Case Number en-US , was � assigned to Judge , and � remains � is no longer � pending. 3. � The minor was born Date , is � female, � male, � is unmarried, resides in County � at Address City/Township State Zip en-US � and is presently located in County en-US at Address (only if different than above) � City/Township State Zip en-US . � � The minor is a citizen of the following foreign country: en-US . 4. � � The minor is not an Indian child as defined in MCR 3.002(12). � � It is unknown whether the minor is an Indian child as defined in MCR 3.002(12). � en-US*Also list persons who had principal care and custody of the minor 5. � The persons interested in this proceeding are: en-USduring the 63 days before filing the petition. en-USNAMEen-USRELATIONSHIPen-USADDRESS AND TELEPHONE NUMBERen-USParent/DOB en-USStreet addressen-USCityen-USStateen-USZipen-USTelephone no.en-USParent/DOB en-USStreet addressen-USCityen-USStateen-USZipen-USTelephone no.en-USConservatoren-USStreet addressen-USCityen-USStateen-USZipen-USTelephone no.en-USGuardianen-USStreet addressName, incapacity, and representative of the person, if any en-US .en-USXXX-XX- American LegalNet, Inc. www.FormsWorkFlow.com en-USFile No.en-US 6. The welfare of the minor will be served by the appointment. 7. A proposed limited guardianship placement plan is attached. en-USI REQUEST: 8. � Name en-USwhose address is Address City/TownshipStateZipTelephone no. en-US be appointed limited guardian of the minor. 9. Other: 10. en-USI CONSENT TO THE SUSPENSION OF MY PARENTAL RIGHTS.en-USI declare under the penalties of perjury that this petition has been examined by me and that its contents are true to the best ofen-USmy information, knowledge, and belief. Date Date Signature of custodial parent Signature of custodial parent Address Address City, state, zipTelephone no. City, state, zipTelephone no. en-USNOTE: If both parents have custody, each must sign. 11. I am 14 years of age or older. I nominate Name en-US as my guardian who lives at AddressCityStateZip en-US . Date Signature of minor Attorney signature Attorney name (type or print)Bar no. Address City, state, zipTelephone no. en-USUSE NOTE: en-USIf a parent is incarcerated and under the jurisdiction of the Michigan Department of Corrections, the petitioner must comply with MCR 2.004(B). American LegalNet, Inc. www.FormsWorkFlow.com