PC 639 Petition for Appointment of Conservator

PETITION FOR APPOINTMENT OF CONSERVATOR AND/OR PROTECTIVE ORDER

STATE OF MICHIGAN PROBATE COURT COUNTY OF FILE NO.

Estate of Last four digits of SSN

Appointment of Conservator Protective Order

1. I, , am interested in this matter and make this petition as

2. The individual was born , resides in County at City, state, zip and has property in County.

3. An action within the jurisdiction of the family division of circuit court involving the family or family members of the above individual has been previously filed in Court, Case Number , was assigned to Judge , and remains is no longer pending

4. The individual has: a power of attorney a guardian a representative payee for social security

Name and address

5a. The individual is an adult unable to manage his/her property and business affairs effectively because of:

mental illness chronic use of drugs detention by a foreign power
mental deficiency chronic intoxication disappearance
physical illness or disability confinement

and either
the adult has property that will be wasted or dissipated unless proper management is provided
the adult or his/her dependents are in need of money for support, care, and welfare, and protection is necessary to obtain or provide money

5b. The adult petitioner is mentally competent but because of age or physical infirmity is unable to manage his/her property and affairs effectively, and recognizing the disability, requests appointment of a conservator.

5c. The individual is a minor who:

owns money or property that requires management or protection that cannot otherwise be provided
has or may have business affairs that may be jeopardized or prevented by minority
needs money for support and education, and protection is necessary or desirable to obtain or provide money

5d. I am the guardian of the ward and it is in the ward's best interests to sell or otherwise dispose of the ward's real property or interest in real property.

6. The statements in item 5 are supported by the following facts:

7. The individual to be protected has an estate approximately valued at:

8. The individual to be protected is receiving the following benefits from governmental agencies:

Social Security $ SSI $
MDHHS $ Veterans Administration $ , claimant number
Other: $

9. The individual to be protected has:

a spouse whose name and address are listed below
child(ren) whose name(s) and address(es) are listed below
descendants of deceased child(ren) whose name(s) and address(es) are listed below
if no child(ren) or descendants of deceased child(ren), parents whose name(s) and address(es) are listed below
if none of the above, presumptive heirs whose name(s) and address(es) are listed below
none of the above (must notify the Attorney General)

Name / Address / Telephone / Relationship / Age-DOB

10. None of the persons named above are under any legal incapacity except

11. The individual is currently found at

12. It is necessary that a preliminary protective order be entered pending the regular hearing because

I REQUEST that the court:

13. Appoint

who has priority as , as conservator of the estate to be protected.

14. Preserve and apply the individual's property pending the appointment of a conservator as follows:

15. Enter a protective order that provides

16. Appoint the guardian as special conservator with authority to sell or otherwise dispose of the ward's real property or interest in real property.

17. NOMINATION BY PERSON TO BE PROTECTED: I am 14 years of age or older. I nominate as my conservator