Free pca322.pmd - Michigan

Approved, SCAO

JIS CODE: OCA

STATE OF MICHIGAN
JUDICIAL CIRCUIT - FAMILY DIVISION

FILE NO. ORDER COMMITTING TO AGENCY/ DEPARTMENT OF HUMAN SERVICES

COUNTY

In the matter of
Full name of child

DOB: Judge:
Bar no.

1. Date of hearing: THE COURT FINDS: 2. The parental rights of
Name Name

Relationship Relationship

have been terminated. 3. It is reasonable not to make efforts to prevent removal of the child or to reunify the family. IT IS ORDERED: 4. The child named above is committed to
Child-placing agency/Michigan Department of Human Services under MCL 710.29(7)

for the purpose of adoption.

Date

Judge

Do not write below this line - For court use only

PCA 322 (9/07)

ORDER COMMITTING TO AGENCY/DEPARTMENT OF HUMAN SERVICES

MCL 710.29(7)