Approved, SCAO
JIS CODE: ADI/ADN
STATE OF MICHIGAN
JUDICIAL CIRCUIT - FAMILY DIVISION
FILE NO. PETITION FOR ADOPTION INFORMATION AND ORDER
COUNTY
In the matter of PETITION
, adoptee
1. I,
Name (type or print)
, am interested in this matter as
adult adoptee. biological parent. adult biological sibling. adoptive parent. other:
specify
2. The adoptee was born
Date
. nonidentifying information
3. I request authorization to receive
identifying information
as follows: (specify)
a certified copy of court-ordered adoption. 4. The reasons for requesting the information are:
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 signature Name (type or print) Address City, state, zip Telephone no. Bar no. Date Petitioner signature Address City, state, zip Telephone no.
ORDER IT IS ORDERED: 5. The petitioner shall receive
nonidentifying information
identifying information
as follows: (specify)
a certified copy of court-ordered adoption. 6. The petition is denied in whole or in part because:
Date
Judge
Bar no.
Do not write below this line - For court use only
PCA 327 (9/07)
PETITION FOR ADOPTION INFORMATION AND ORDER
MCL 710.67, MCL 710.68