Free pca349.pmd - Michigan

Approved, SCAO

JIS CODE: PFR

STATE OF MICHIGAN
JUDICIAL CIRCUIT - FAMILY DIVISION

FILE NO. PETITION FOR RESCISSION OF ADOPTION AND ORDER

COUNTY

In the matter of
Full name of child at birth Full name of child immediately after adoption Birth date

, adoptee

1. I,
Adoptee's present name

was adopted by
Stepparent's name Birth parent's name

.

2. I,

, birth parent, had my parental rights terminated by order of this court.

3. I desire to rescind the adoption by the stepparent and restore the parental rights of the birth parent. 4. The adoptee's name will be
First Middle Last

.

5. The adoptee's legal parents are:
Name of natural parent Address City, state, zip Telephone no. Name of adoptive stepparent Address City, state, zip Telephone no.

I REQUEST the court to conduct a hearing, and an investigation if necessary, and enter an order of rescission of the adoption and restore the parental rights of the petitioner birth parent. I declare that this petition has been examined by me and that its contents are true to the best of my information, knowledge, and belief.
Date Signature of adoptee petitioner Address City, state, zip Date Signature of birth parent petitioner Address City, state, zip Attorney signature Address Attorney name (type or print) City State Zip Telephone no. Bar no. Telephone no. Telephone no.

IT IS ORDERED: 6. The adoption of the adoptee named above by the stepparent named above is rescinded and the parental rights of the birth parent named above are restored. 7. The petition is denied.
Date Judge Bar no.

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PCA 349 (9/07)

PETITION FOR RESCISSION OF ADOPTION AND ORDER

MCL 710.66