Free Statement of Preference - Michigan


File Size: 20.1 kB
Pages: 1
Date: February 12, 2008
File Format: PDF
State: Michigan
Category: Juvenile - Court Forms
Word Count: 203 Words, 1,202 Characters
Page Size: Letter (8 1/2" x 11")
URL

http://courts.michigan.gov/scao/courtforms/juvenile/jc51.pdf

Download Statement of Preference ( 20.1 kB)


Preview Statement of Preference
Approved, SCAO

Court file only

STATE OF MICHIGAN
JUDICIAL CIRCUIT - FAMILY DIVISION

COUNTY
Court address

STATEMENT OF PREFERENCE

CASE NO. PETITION NO.

Court telephone no.

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

2. The above named American Indian child has been placed with: a. a member of his or her extended family.
Full name (type or print) City, county, and state

b. a foster home licensed, approved, or specified by the child's tribe.
Full name (type or print) City, county, and state

c. other Indian foster family licensed or approved by a non-Indian licensing authority.
Full name (type or print) City, county, and state

d. An institution for children approved by an Indian tribe or operated by an Indian organization that has a program suitable to meet the child's needs:
Full name (type or print) City, county, and state

e. other non-Indian family.
Full name (type or print) City, county, and state

3. The good cause for not placing the child with a family having preference under the Indian Child Welfare Act of 1978 is:

Date

Signature Placing agency

Do not write below this line - For court use only

JC 51 (6/03)

STATEMENT OF PREFERENCE

25 USC 1915, MCR 3.980(C)(5)