Fillable COUNTY OF WAYNE Permanent Custody (Third Judicial Circuit of Michigan)

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COUNTY OF WAYNE Permanent Custody (Third Judicial Circuit of Michigan)

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Approved SCAO OSM CODE: PET
STATE OF MICHIGAN PETITION CASE NO.
COUNTY OF WAYNE Permanent Custody
THIRD JUDICIAL CIRCUIT COURT Court to Consent PE
TITION NO.
FAMILY
DIVISION (PAGE 1 of 2)
1. In the matter
of: ________________________________________________ DOB: ______________________
2. The above named m
inor comes within the provisions of MCL 712A.2(b)(5).
A. A Guardianship Order was entered on ____________________________.
B. The parent
has neglected their child contrary to MCL 712A.2(b)(5) in the following manner:
1. The parent(s
), having the ability to support or assist in supporting the juvenile, has failed or neglected, without good
cause, to provide regular and substantial support for the juvenile for 2 years or more before the filing of the petition or,
if a support order has been entered, has failed to substantially comply with the order for 2 years or more before the
filing of the petition. MCL 712A.2(b)(5)(A).
2. The parent
(s), having the ability to visit, contact, or communicate with the juvenile, has regularly and substantially
failed or neglected, without good cause, to do so for a period of 2 years or more before the filing of the petition. MCL
712A.2(b)(5)(B).
C.
An Order for Authority to Adopt was granted to the guardian(s) on:
D.
The mother of the child is:
She resides at:
She died on:
Her whereabouts is unknown
She does does not have a support order entered against her.
E.
The father of the child is:
He resides at:
He died on:
His whereabouts is unknown
He
has
has not
He
has
has not
He
does
does not
He
does
does not
IT IS THEREFORE REQUESTED THAT:
1. The parental rights of the mother father
be terminated pursuant to MCL 712A.19b(3)(f) for these reasons:
A. The pare
nt(s), having the ability to support or assist in supporting the minor, has failed or neglected, without good
cause, to provide regular and substantial support for the minor for a period of 2 years or more before the filing of the
petition or, if a support order has been entered, has failed to substantially comply with the order for a period of 2 years or
more before the filing of the petition.
B. The parent
(s), having the ability to visit, contact, or communicate with the minor, has regularly and substantially failed
or neglected, without good cause, to do so for a period of 2 years or more before the filing of the petition.
Clear Form
Approved SCAO OSM CODE: PET
STATE OF MICHIGAN PETITION CASE NO.
COUNTY OF WAYNE Permanent Custody
THIRD JUDICIAL CIRCUIT COURT Court to Consent PE
TITION NO.
FAMILY
DIVISION (PAGE 2 of 2)
2. The Court
takes permanent custody of the child and consent to the adoption.
3. The Court r
ecords reflect the correct name and birth date of the child as:
Name:_________________________________________________ DOB: ___________________.
The Child is a member of or eligible for membership in an American Indian Tribe or Band.
4. The minor is is not subject to the prior continuing jurisdiction of ________________________ court.
5. The above nam
ed minor is a resident of Wayne County, and resides in the care and custody of guardians(s):
Name(s)
: ______________________________________ and ______________________________________.
6. The names and addresses of the parents, guardians, and custodians, or nearest known relatives are as follows:
Name
(one name per line)
Address
Mother
Legal Father
Putative Father(s)
Guardian(s)
7. I request
the Court to review the information, take temporary and permanent custody of the minor and terminate
parental rights
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.
1. Petitioner Signature
Date
Attorney Name
Petitioner Name
Attorney Address
2. Petitioner Signature (if more than one petitioner)
Date
Attorney Telephone Number
Petitioner Name (if more than one petitioner)
Petitioner Address
Date
Judge/Referee
Bar No.
=====================================================================
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COUNTY OF WAYNE Permanent Custody (Third Judicial Circuit of Michigan)

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Completed 29 July 2020

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