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FOR THE THIRD JUDICIAL CIRCUIT OF MICHIGAN (Third Judicial Circuit of Michigan)

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THE CIRCUIT COURT
FOR THE THIRD JUDICIAL CIRCUIT OF MICHIGAN
FAMILY DIVISION – JUVENILE
RE: Request for a Confidential Intermediary
The Court is in receipt of your request for a Confidential Intermediary (PCA 342). Adoption Records are maintained
in the county where the adoptive parents lived at the time of the adoption. In order to process your request, it is
necessary that you provide the following item(s):
• There is a $20.00 filing fee for the petition. Please make your money order (NO PERSONAL CHECKS)
payable to Wayne County Clerk. Once the intermediary has been appointed, the Court has authorized
him/her to charge $250.00 plus costs (phone, postage, any documents that might need to be obtained from
any agency). This fee is not due until the intermediary has contacted you and the CI will not begin the search
until the fee is paid. If you have not made payment after six months, your file will be dismissed and you will
need to petition the Court again, requiring an additional $20.00 filing fee.
• Please provide picture identification and a copy of your birth certificate.
• Please complete the enclosed form(s).
• If you received non-identifying information from an agency, please submit a copy.
Please mail 1) the additional information or fee 2) your letter or request if it was returned to you
3) a copy of this letter to:
Adoptions Unit – Post Adoptions
1025 E. Forest Avenue
Detroit, MI 48207
(313) 833-1880
PCA 342 (2/15) PETITION AND ORDER TO APPOINT CONFIDENTIAL INTERMEDIARY
In the matter of , adoptee
1. I am an adult adoptee. adoptive parent of the adoptee who is a minor.
adult child of the deceased adoptee whose date of death is .
I REQUEST that the court appoint a confidential intermediary to search for and contact a former family member of mine
who is believed to be my
mother. father. grandparent. adult sibling.
2. I am a former family member of the adoptee. I am the adoptee's
parent. grandparent. adult sibling.
I REQUEST that the court appoint a confidential intermediary to search for and contact
the adult adoptee. an adult child of the deceased adoptee whose date of death is .
ORDER
3. Date of hearing: Judge:
4. is appointed confidential intermediary to search for and
contact the former mother. the former father. the former grandparent.
the adult adoptee. an adult child of the deceased adoptee. adult sibling.
The confidential intermediary shall file with the court within 6 months of this order a written report of the intermediary's efforts
to search for and contact the individual and any results. The confidential intermediary shall have access to the adoptee's court
file and records.
5. The former mother former father has on file with the central adoption registry a denial of consent to the
release of identifying information. The petition to search for that former parent is denied.
Approved, SCAO
FILE NO.
PETITION AND ORDER TO APPOINT
CONFIDENTIAL INTERMEDIARY
MCL 710.68b
Full name of child
PETITION
Date
Do not write below this line - For court use only
Name (type or print)
STATE OF MICHIGAN
JUDICIAL CIRCUIT - FAMILY DIVISION
COUNTY
Date
Date
Date
Name of petitioner (type or print)
City, state, zip
Telephone no.
Signature of petitioner
Address
Bar no.
Judge
JIS CODE: ACI
3rd
WAYNE
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FOR THE THIRD JUDICIAL CIRCUIT OF MICHIGAN (Third Judicial Circuit of Michigan)

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Completed 29 July 2020

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