Approved, SCAO
JIS CODE: OCA
STATE OF MICHIGAN
JUDICIAL CIRCUIT - FAMILY DIVISION
FILE NO. ORDER COMMITTING TO AGENCY/ DEPARTMENT OF HUMAN SERVICES
COUNTY
In the matter of
Full name of child
DOB: Judge:
Bar no.
1. Date of hearing: THE COURT FINDS: 2. The parental rights of
Name Name
Relationship Relationship
have been terminated. 3. It is reasonable not to make efforts to prevent removal of the child or to reunify the family. IT IS ORDERED: 4. The child named above is committed to
Child-placing agency/Michigan Department of Human Services under MCL 710.29(7)
for the purpose of adoption.
Date
Judge
Do not write below this line - For court use only
PCA 322 (9/07)
ORDER COMMITTING TO AGENCY/DEPARTMENT OF HUMAN SERVICES
MCL 710.29(7)