Form Pc 652 PDF Details

In navigating the complexities of legal guardianship in Michigan, the PC 652 form serves as a vital tool for parents and guardians aiming to establish a limited guardianship placement plan. This form, formally recognized and utilized by the State of Michigan's Probate and Family Division Courts, outlines the specifics of an agreement between a child’s custodial parent(s) and a proposed guardian. Notably, the form encompasses comprehensive sections that demand thoughtful completion to adhere to Michigan Compiled Laws 700.5205(2), including reasons for seeking limited guardianship, arrangements for maintaining parent-child relationships, financial support commitments, and the envisioned duration of the guardianship. By signing this document, custodial parents express their consent to the outlined conditions, even if these require separate documentation due to diverging perspectives or needs. The form further extends to capture agreements on visitation schedules, communication plans, educational and medical provisions, among others, ensuring a structured approach to the minor's welfare under limited guardianship. The completion and approval of this document signify a legal agreement, shaped by the shared responsibility towards the minor's needs, making it a cornerstone in safeguarding the child's well-being while under the care of a guardian other than the custodial parent(s).

QuestionAnswer
Form NameForm Pc 652
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namespc652 limited guardianship michigan form

Form Preview Example

Approved, SCAO

JIS CODE: LGP

STATE OF MICHIGAN PROBATE COURT

COUNTY

CIRCUIT COURT - FAMILY DIVISION

LIMITED GUARDIANSHIP

PLACEMENT PLAN

FILE NO.

In the matter of

 

, a minor

Special Note in Completing Form:

Items 1 through 4 must be completed to comply with MCL 700.5205(2).

Each custodial parent who signs this plan is agreeing to all the conditions of the plan even though each item refers to a single person. When more than one parent enters into this agreement and they differ from one another in any area of the plan, each parent must complete their own plan on separate forms. For example:

• If they differ in their reasons for the guardianship, each parent must specify their own reasons.

This plan modifies a limited guardianship placement plan previously approved by the court.

As custodial parent, I desire to establish a limited guardianship for my child and agree to the following plan:

1. The reason I want a limited guardianship is:

 

 

 

 

 

 

 

 

 

To enable my child to attend school in the proposed guardian's school district.

 

 

 

 

 

To provide health insurance through the proposed guardian.

 

 

 

 

 

 

 

 

I will be or am incarcerated until

 

 

 

 

 

.

 

 

 

 

 

I am currently without housing adequate for my child.

 

 

 

 

 

 

 

 

I am unable to care for my child because of my health.

 

 

 

 

 

 

 

 

I am unable to care for my child because of my mental instability.

 

 

 

 

 

 

 

I desire an alternative to action recommended by child protective services.

 

 

 

 

 

 

I have lost substantial control of my child's behavior.

 

 

 

 

 

 

 

 

I need to improve my parenting skills.

 

 

 

 

 

 

 

 

 

 

The minor's physical needs for food, clothing, and housing may best be met by the proposed guardian.

 

 

To comply with the requirement of the

Reserves.

Armed Forces.

 

 

 

 

 

 

Other:

 

 

 

 

 

 

 

 

 

 

 

 

2. Visits and contact with my child will be sufficient to maintain my parent and child relationship and will be as follows:

 

I will visit my child on: (please circle each day you plan to visit)

Su

M

Tu

W

Th

F

Sa

 

from: (please specify the time and circle either a.m. or p.m.)

 

a.m.

p.m.

 

to

 

a.m.

p.m.

I will visit my child

times each

week.

month.

 

 

 

 

 

 

Visits will occur at

my residence.

the proposed guardian's residence.

 

 

 

.

 

Telephone contact will take place

 

daily.

weekly.

 

monthly.

 

 

 

 

.

 

Letters will be sent

daily.

weekly.

monthly.

 

 

 

 

.

 

 

 

I will attend my child's school conference provided I receive timely notice of the conference.

 

 

 

I will attend counseling with my child.

 

 

 

 

 

 

 

 

 

 

I will participate in and arrange positive outings with my child

daily.

weekly.

 

monthly.

 

 

.

I will provide transportation for my child for

 

 

 

 

 

.

 

 

 

I will attend all doctor/dental appointments for my child (excluding emergencies).

 

 

 

 

 

Transportation to and from visits with my child will be the responsibility of

 

 

 

 

 

.

Collect telephone calls will be accepted at number

 

 

.

 

 

 

 

 

Other:

 

 

 

 

 

 

 

 

 

 

 

 

SEE OTHER SIDE FOR REMAINING PLANS

Do not write below this line - For court use only

Approved:

Date

Judge

PC 652 (9/05) LIMITED GUARDIANSHIP PLACEMENT PLAN

MCL 700.5205(2), MCR 5.404(A), (B)

3. Financial support will be made by me as follows:

 

 

 

Health insurance coverage through

 

 

.

 

Policy numbers are

.

 

 

School lunch money, clothing, supplies.

 

 

 

Car insurance.

 

 

 

$

each month for room, board, miscellaneous expenses to be paid at month's

end.

beginning.

I will pay for counseling.

I will pay for transportation to and from visits.

I will provide food for my child as follows:

I will pay for babysitting as follows:

Other:

4.My plan is for the limited guardianship to continue until: The end of the current school year.

I graduate

my child graduates

from high school.

I am able to provide a drug-free household.

 

I complete parenting classes.

 

I am no longer

incarcerated.

on parole/probation.

I am gainfully employed.

I have established myself in a new residence.

I have successfully completed drug or alcohol inpatient/outpatient treatment.

I have cooperated with a substance abuse assessment and have followed the recommendations of the assessment. I have cooperated with a psychological evaluation and have followed the recommendations of the assessment.

I have successfully completed psychological counseling.

My child can accept my parental authority.

 

I complete my

G.E.D.

job training.

I no longer cohabitate with individuals.

I cooperate with a domestic assault program. I have health insurance coverage for my child.

I have completed my obligation to the Reserves or Armed Forces. Other:

5. I also agree as follows:

As a custodial parent of the minor, I understand that if I substantially fail, without good cause, to follow this plan, my parental rights may be terminated by the court through proceedings under the juvenile code.

Date

Signature

Name of custodial parent (type or print)

Address

City, state, zip

Telephone no.

Date

Signature

Name of custodial parent (type or print)

Address

City, state, zip

Telephone no.

Agreement and Acceptance of Appointment by Limited Guardian

I will serve as limited guardian of the minor. I agree with this plan, and I accept the appointment and agree to file reports and to perform all duties required by law.

Date

 

 

Date

 

 

 

 

 

 

Signature

 

 

Signature

 

 

 

 

 

 

Name of proposed guardian (type or print)

 

 

Name of proposed guardian (type or print)

 

 

 

 

 

 

Address

 

 

Address

 

 

 

 

 

 

City, state, zip

Telephone no.

 

City, state, zip

Telephone no.

Date of birth

Driver license no. or other identification

Date of birth

Driver license no. or other identification

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With regards to the fields of this precise document, here is what you should do:

1. Firstly, once filling out the Form Pc 652, begin with the page that contains the following blank fields:

The way to complete Form Pc 652 stage 1

2. The third stage would be to fill in the following blank fields: To enable my child to attend, Armed Forces, Reserves, Visits and contact with my child, I will visit my child on please, from please specify the time and, daily, daily, week, month, weekly, weekly, times each my residence, the proposed guardians residence, and I will visit my child Visits will.

Writing part 2 of Form Pc 652

Concerning the proposed guardians residence and week, ensure you review things in this section. Those two are certainly the most important fields in this file.

3. Completing Financial support will be made by, Health insurance coverage through, Policy numbers are, each month for room board, School lunch money clothing, My plan is for the limited, The end of the current school year, I graduate, my child graduates, from high school, end, beginning, incarcerated, on paroleprobation, and I am able to provide a drugfree is essential for the next step, make sure to fill them out in their entirety. Don't miss any details!

Guidelines on how to prepare Form Pc 652 portion 3

4. The following section needs your information in the subsequent parts: I am able to provide a drugfree, I also agree as follows, As a custodial parent of the minor, Date, Signature, Date, Signature, Name of custodial parent type or, Name of custodial parent type or, Address, City state zip, Address, Telephone no, City state zip, and Telephone no. Remember to give all needed info to move forward.

Filling in section 4 of Form Pc 652

5. As a final point, the following final portion is precisely what you have to complete before submitting the PDF. The blank fields under consideration are the next: I will serve as limited guardian, Date, Signature, Date, Signature, Name of proposed guardian type or, Name of proposed guardian type or, Address, City state zip, Address, Telephone no, City state zip, Telephone no, Date of birth, and Driver license no or other.

Filling in section 5 of Form Pc 652

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