Free pca318.pmd - Michigan

Approved, SCAO

JIS CODE: OTA

STATE OF MICHIGAN
JUDICIAL CIRCUIT - FAMILY DIVISION

FILE NO. ORDER TERMINATING PARENTAL RIGHTS AFTER RELEASE OR CONSENT

COUNTY

In the matter of

Full name of child

DOB: Judge:

, adoptee
Bar no.

1. Date of hearing: THE COURT FINDS:

2. A release of the child has been executed according to law by
Name(s)

. 3. The consent to the adoption is genuine and is given by the person(s) having legal authority to sign the consent and the best interests of the adoptee will be served by the adoption. IT IS ORDERED: 4. The parental rights of
Name(s)

are terminated.

Date

Judge

Do not write below this line - For court use only

PCA 318 (9/07)

ORDER TERMINATING PARENTAL RIGHTS AFTER RELEASE OR CONSENT

MCL 710.29(7), MCL 710.55(1)