Approved, SCAO OSM CODE: RGW, DIS STATE OF MICHIGAN PROBATE COURT COUNTY OF In the matter of FILE NO. RECEIPT OF WARD AND DISCHARGE , a protected individual 1. I am an adult. I have received from Name , my guardian or conservator, the following personal property: It is the balance of the estate due me in full. 2. I REQUEST that my guardianship or conservatorship be terminated. Date Signature Name (type or print) Address City, state, zip Telephone no. ORDER IT IS ORDERED the guardianship and/or conservatorship is terminated, the guardian and/or conservator is discharged, and the bond, if any, is cancelled. Date Judge Bar no. Attorney name (type or print) Address City, state, zip Bar no. Telephone no. USE NOTE: If this form is being filed in the circuit court family division, please enter the court name and county in the upper left-hand corner of the form. Do not write below this line - For court use only PC 649 (9/10) RECEIPT OF WARD AND DISCHARGE American LegalNet, Inc. www.FormsWorkFlow.com