Free pca302.p65 - Michigan

Approved, SCAO

JIS CODE: SPT

STATE OF MICHIGAN
JUDICIAL CIRCUIT - FAMILY DIVISION

COUNTY In the matter of

SUPPLEMENTAL PETITION AND AFFIDAVIT TO TERMINATE PARENTAL RIGHTS OF NONCUSTODIAL PARENT

FILE NO.

Full name of child

DOB: SUPPLEMENTAL PETITION

, adoptee

I,

Name (type or print) Name (type or print)

, am the custodial parent of the child named above, and I request , the noncustodial parent of the child, be

that the parental rights of

terminated because of lack of support of and parenting time with the child.
Date Custodial parent signature

AFFIDAVIT 1. I have joined in a petition with on
Date Name (type or print)

, whom I married

, requesting the adoption of the child named above and the termination of the

parental rights of the noncustodial parent named above. 2. The noncustodial parent and I were divorced on
Date

. A copy of the judgment of

divorce and any subsequent orders are attached and filed with the court. 3. The noncustodial parent acknowledged paternity on of paternity is attached and filed with the court. 4. I have legal custody of the child. 5. a. A support order has been entered and the noncustodial parent has failed to substantially comply with the order for a period of two years or more before the petition for adoption was filed. b. A support order has not been entered and the noncustodial parent, having the ability to support the child, has failed or neglected to provide regular and substantial support for two years or more before the petition for adoption was filed. 6. The noncustodial parent has had the ability to visit, contact, and communicate with the child and has regularly and substantially failed or neglected to do so for a period of two years or more before the petition for adoption was filed. (PLEASE SEE OTHER SIDE)
Do not write below this line - For court use only
Date

. A copy of the acknowledgment

PCA 302 (11/05)

SUPPLEMENTAL PETITION AND AFFIDAVIT TO TERMINATE PARENTAL RIGHTS OF NONCUSTODIAL PARENT MCL 710.26, MCL 710.51(6), MCR 3.801

7. The last known address of the noncustodial parent is

8.

a. The noncustodial parent is living at the above address. b. The noncustodial parent is not living at the above address, and I have taken the following steps to locate him/her.

Attorney signature Attorney name (type or print) Address City, state, zip Telephone no. Bar no.

Date Signature of custodial parent petitioner Address City, state, zip Telephone no.

Subscribed and sworn to before me on My commission expires:
Date

Date

, Signature:
Notary public/Deputy clerk

County, Michigan.

Notary public, State of Michigan, County of