Scribd
Upload
28 views2 pages

PC 684 Completed

The document is an application for the appointment of an out-of-state guardian for two minor children. It provides biographical information on the minors and guardian as well as parental information. The applicant is requesting the court appoint her as guardian of the minors according to the laws of the state.

Uploaded by

Jeremy Shepard
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
28 views2 pages

PC 684 Completed

The document is an application for the appointment of an out-of-state guardian for two minor children. It provides biographical information on the minors and guardian as well as parental information. The applicant is requesting the court appoint her as guardian of the minors according to the laws of the state.

Uploaded by

Jeremy Shepard
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 2

PCS CODE: AOM/OOM

Approved, SCAO TCS CODE: AOGM/OOM

STATE OF MICHIGAN FILE NO.


PROBATE COURT APPLICATION AND ORDER FOR
COUNTY OF Ingham APPOINTMENT OF
OUT-OF-STATE GUARDIAN OF MINOR

In the matter of Neveah Rose Hesterly, and Serenity Lynn Hesterly , a minor XXX-XX-
First, middle, and last name Last four digits of SSN

USE NOTE: If a parent is incarcerated and under the jurisdiction of the Michigan Department of Corrections, the petitioner must comply with MCR 2.004(B).

1. I, Kristen Shepard ,am interested in this matter and


Name

make this application as the individual’s guardian appointed, qualified, and serving in good standing in another state.

2. I am not aware of any guardianship or pending petitions in this state for a guardianship of the minor.

3. The minor was born 02/05/2018, 01/07/2017 , is ✔


female, male, is unmarried, resides in Ingham
Date County

at 1765 S. Aurelius Mason MI 48854


Address City/Township State Zip

and is presently located in Ingham at


County Address (if different than above)

.
City/Township State Zip

The minor is a citizen of the following foreign country: .

4. An action within the jurisdiction of the family division of circuit court involving the family or family members of the above

minor has been previously filed in Court, Case Number , was

assigned to Judge , and   remains is no longer   pending.



5. The persons interested in this proceeding are:
NAME RELATIONSHIP ADDRESS AND TELEPHONE NUMBER
Danielle Sissom Street address
7620 E. 4th Ave
Parent/DOB Mother
City State Zip Telephone no.
Stillwater OK 74074
Leslie Hesterly Street address
7620 E. 4th Ave
Parent/DOB Father
City State Zip Telephone no.
Stillwater OK 74074
Street address
Conservator
City State Zip Telephone no.

Kristen Shepard Street address


Person with care/ 1765 S. Aurelius
custody of minor* City State Zip Telephone no.
Mason MI 48854 517-582-7962
None of these persons are under any legal incapacity except .
Name, incapacity, and representative of the person, if any

(SEE SECOND PAGE)


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

MCL 700.5202a, MCR 3.206(A)(4), MCR 5.107, MCR 5.125(C)(19)


PC 684 (12/17) APPLICATION AND ORDER FOR APPOINTMENT OF OUT-OF-STATE GUARDIAN OF MINOR
Application and Order for Appointment of Out-of-State Guardian of Minor (12/17) File No.

6. The minor is a member of an Indian tribe or is eligible for membership in an Indian tribe. The name of the tribe is

✔
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).

7. The minor has a conservator. (Specify name and address below).


Name and address

8.
Name of court that appointed guardian State Telephone no.

appointed the guardian for the following reason(s):

9. I REQUEST that the court of this state appoint me guardian of the minor in accordance with the laws of this state.

I declare under the penalties of perjury that this application has been examined by me and that its contents are true to the best
of my information, knowledge, and belief.

Attorney signature Date

Attorney name (type or print) Bar no. Applicant signature

Address Address

City, state, zip Telephone no. City, state, zip Telephone no.

ORDER APPOINTING GUARDIAN

1. An application for appointment of a guardian of a minor was filed in this court along with an authenticated copy of the
guardian’s letters of appointment in the other state and an acceptance of appointment in this state.

IT IS ORDERED:

2. Kristen Shepard is appointed temporary guardian of


Name of guardian (type or print)
Neveah Rose Hesterly , Serenity Lynn Hesterly , a minor in this state.
Name of minor (type or print)

Date Judge Bar no.

NOTICE TO INTERESTED PERSONS

Unless an objection to the above appointment is filed with the court within 28 days of the date of the order appointing, the
temporary guardian shall be appointed full guardian of the minor.

NOTE TO APPLICANT: Within 14 days of your appointment as the temporary guardian, you must send, by first-class mail, a
copy of this application, order, and notice to all interested persons and file proof of service with this court.

You might also like

pFad - Phonifier reborn

Pfad - The Proxy pFad of © 2024 Garber Painting. All rights reserved.

Note: This service is not intended for secure transactions such as banking, social media, email, or purchasing. Use at your own risk. We assume no liability whatsoever for broken pages.


Alternative Proxies:

Alternative Proxy

pFad Proxy

pFad v3 Proxy

pFad v4 Proxy