Fillable AFFIDAVIT AND ORDER EXCUSING RESPONDENT’S PRESENCE (Oakland County)

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STATE OF MICHIGAN - AFFIDAVIT AND ORDER EXCUSING RESPONDENT’S PRESENCE (Oakland County)

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STATE OF MICHIGAN
PROBATE COURT
OAKLAND COUNTY
AFFIDAVIT AND ORDER
EXCUSING RESPONDENT’S PRESENCE
FILE NO.
In the matter of , an individual with a developmental disability
AFFIDAVIT
1. I am a licensed physician psychologist in the State of Michigan.
2. I examined the above named respondent on .
Date
3. It is my professional opinion that attendance at any and all proceedings in this matter would subject the respondent to serious
risk of physical or emotional harm for the reason that:
4. I request that the respondent’s presence be excused.
Affiant Signature
Subscribed and sworn to before me on , County, Michigan.
Date
My commission expires: Signature:
Date Deputy clerk/Register/Notary public
ORDER
IT IS ORDERED that:
The Request to Excuse Respondent’s Presence is:
1. Granted
2. Denied
Date
Judge Bar no.
Do not write below this line – For court use only
FILED
20
Deputy Register of Probate
PEMH 1100 (4/06) AFFIDAVIT AND ORDER EXCUSING RESPONDENT’S PRESENCE MCL 330.1617(4)
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AFFIDAVIT AND ORDER EXCUSING RESPONDENTS PRESENCE (Oakland County)

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Completed 30 August 2020

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