Free pca301.pmd - Michigan

Approved, SCAO

JIS CODE: APF

STATE OF MICHIGAN
JUDICIAL CIRCUIT - FAMILY DIVISION

COUNTY

PETITION FOR ADOPTION Stepparent Related Within 5th Degree Other (Excluding Direct Adoption)

FILE NO.

In the matter of I,
Name

Full name of child

, adoptee , join with my spouse in this petition for adoption (Applicable to stepparent adoption only.)

Name

Relationship to Adoptee

Address, City, State, Zip

Date and Place of Birth

Adopting Mother
Maiden:

Adopting Father Each adopting petitioner states: 1. An action within the jurisdiction of the family division of circuit court involving the family or family members of the minor has been previously filed in assigned to Judge 2. I desire to adopt:
Full name of child City, county, and state of birth Present residential address (if known) Birth date and time

Court, Case Number , and remains is no longer

, was pending.

3. The adoptee will be my heir at law. not be changed. 4. The adoptee's name will be changed to 5. The adoptee's property is 6. The adoptee's parents are:
Father's name Address City, state, zip

First

Middle

Last

. .

Birth date

Mother's name (and maiden name) Address City, state, zip

Birth date

unknown because the rights of the parents have been terminated by a court of competent jurisdiction and parental rights are vested in
Name and address of court or agency

. (PLEASE SEE OTHER SIDE)

Do not write below this line - For court use only

PCA 301 (9/07)

PETITION FOR ADOPTION

MCL 710.24, MCL 710.26, MCL 710.45, MCL 710.46, MCL 710.52, MCL 710.56

7. The adoptee's court-appointed guardian and/or conservator is/are (attach copy[ies] of letters of authority)
Name(s) and address(es)

. 8. The adoptee has been living with the petitioners in their home for 9. months before filing this petition.

(Applies only to stepparent adoptions.) The noncustodial parent has failed to provide support or comply with a support order and

failed to visit or contact the adoptee for a period of 2 years or more. Affidavit to Terminate Parental Rights of Noncustodial Parent.) 10. I have been unable to obtain the required consent to adopt the child from the court, Michigan Department of Human Services or child-placing agency having permanent custody or from the persons to whom the child was released. A motion alleging that the decision to withhold consent was arbitrary and capricious is attached. I REQUEST: 11. Termination of all existing parental rights inconsistent with the order of adoption, entry of an order approving placement of the child with me, and entry of an order of adoption with the adoptee's name recorded as . 12. The adoption be completed immediately because:

(Attach form PCA 302, Supplemental Petition and

13. The court to waive the required investigation because the adoptee has been placed in foster care with me for at least 12 months and a foster family study was completed or updated within the last 12 months.

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.
Attorney/Agency signature Attorney/Agency name (type or print) Address City, state, zip Telephone no. Bar no. Date Signature of petitioner mother Signature of petitioner father Petitioner telephone no.

IT IS ORDERED: 14.
Court agent or employee, child-placing agency, or Michigan Department of Human Services

is directed to fully investigate and report its findings in writing to this court, within 3 months of this order, in accordance with the provisions of MCL 710.46. 15. The full investigation is waived. The petitioner(s) shall file a copy of the most recent foster family study as updated and supplemented.
Date Judge Bar no.