Free pca334.pmd - Michigan

Approved, SCAO

JIS CODE: CRE

STATE OF MICHIGAN
JUDICIAL CIRCUIT - FAMILY DIVISION

FILE NO. CLERK'S REPORT TO PROSECUTING ATTORNEY

COUNTY

In the matter of

Full name of child

DOB:

NOTICE TO PROSECUTING ATTORNEY: 1. The child named above was temporarily placed with prospective adoptive parents for purposes of adoption as indicated in the attached statement (attach form PCA 330 or PCA 331). 2. According to court records, no petition for adoption has been filed and the child has not been returned to the parent(s) or other person having the right to legal custody as required and no petition to determine custody of the child has been filed. TAKE NOTICE: 3. The Michigan Adoption Code requires that the prosecuting attorney for the county where the child has been temporarily placed for adoption shall immediately file a petition in the circuit court to determine the custody of the child.

Date

Signature of clerk

Do not write below this line - For court use only

PCA 334 (9/07)

CLERK'S REPORT TO PROSECUTING ATTORNEY

MCL 710.23d