Free jc44.p65 - Michigan

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JIS CODE: ADV

STATE OF MICHIGAN
JUDICIAL CIRCUIT - FAMILY DIVISION

COUNTY
Court address

ADVICE OF RIGHTS AFTER ORDER TERMINATING PARENTAL RIGHTS (Juvenile Code)

CASE NO. PETITION NO.

Court telephone no.

1. In the matter of
(name(s), alias(es), DOB)

2. On

Date

an order was entered terminating your parental rights to the child(ren) named

above. 3. You have the right to a. appeal the order terminating your parental rights to the Court of Appeals for the State of Michigan, or file a motion for rehearing with this court, within 14 days after the date of the order terminating your parental rights. b. an attorney for appeal/rehearing purposes, and if you cannot afford an attorney, the court will appoint one for you. If you desire a court-appointed attorney, you must file the request on the other side of this form within 14 days after the date of personal service or mailing of service of the order terminating your parental rights or within 14 days after an order denying a timely filed postjudgment motion. 4. If the court appoints an attorney to perfect your appeal, the court will furnish the attorney with the portions of the transcripts and court records the attorney requires for the appeal. 5. In addition to the above rights you have the right to control the release of identifying information about yourself under the adoption laws of this state as follows: a. You may file with the Central Adoption Registry of the Michigan Department of Human Services, at any time, a form called "Parent's Consent/Denial to Release Information to Adult Adoptee". With this form (copies available at all circuit courts or Department of Human Services offices) you can consent to or deny the release of the following identifying information: · your name at the time of termination of your parental rights. · your most recent name and address which is on file with the Central Adoption Registry. You can use this form any time you change your mind about consenting to or denying the release of identifying information. b. You may keep your name and address current with the Central Adoption Registry by sending this information to them in writing. NOTE: If you do not file a "Parent's Consent/Denial to Release Information to Adult Adoptee", or if you revoke a previously filed denial, then the identifying information stated in item 4 will be released upon request of each child after reaching the age of 18. If the other former parent has filed a denial of release of identifying information which has not been revoked, the identifying information about that parent will not be released. (Please see other side for Request for Court-Appointed Attorney)
Date of mailing/service Do not write below this line - For court use only

MCL 712A.21, MCL 710.27a, MCR 3.977(I), MCR 3.992, MCR 7.204(A)(1)(c) JC 44 (11/05)

ADVICE OF RIGHTS AFTER ORDER TERMINATING PARENTAL RIGHTS (Juvenile Code)

REQUEST FOR COURT-APPOINTED ATTORNEY I request a court-appointed attorney to appeal or request a rehearing of the order terminating my parental rights. I am unable to pay for the services of an attorney and request that one be appointed by the court. I have completed the financial schedule below. I understand that I may be ordered to repay the court for all or part of the attorney fees. I authorize the court to investigate and obtain relevant information from my employer, creditors, and others who have knowledge of my financial circumstances for purposes of aiding the court in determining my eligibility for the appointment of an attorney.
Signature Name (please print) Address City, state, and zip Telephone no.

Complete this Financial Schedule if you are seeking a court-appointed attorney. FINANCIAL SCHEDULE
1. RESIDENCE Rent 2. MARITAL STATUS Single 3. INCOME Married Divorced Separated
b. Length of employment

Own

Live with parents

Room/Board

Dependents:

Number

a. Employer name and address

c. Average pay

weekly Gross: $

monthly Net: $

every two weeks

d. Other income (state monthly amount and source [DHS, VA, rent, pensions, spouse, unemployment, child support, etc.])

4. ASSETS

State value of car, home, bank deposits, bonds, stocks, etc.

5. OBLIGATIONS

Itemize monthly rent, installment payments, mortgage payments, child support, etc.

6. REIMBURSEMENT

I understand that I may be ordered to reimburse the court for all or part of my attorney and defense costs.

I declare under penalty of contempt of court that the above information is true to the best of my information, knowledge, and belief.
Date Signature