© 2017 Family Law Self-Help Center Order to Terminate Parental Rights
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OTPR
Your Name:
Address:
Telephone:
Email Address:
Self-Represented
DISTRICT COURT
CLARK COUNTY, NEVADA
In the Matter of the Parental Rights as to:
(children’s names)
____________________________________
____________________________________
____________________________________
Minor Child(ren).
CASE NO.: ____________________
DEPT: ____________________
HEARING DATE: _______________
HEARING TIME: _______________
ORDER TO TERMINATE PARENTAL RIGHTS
This matter having come on for Hearing on the above date and time in the Family Division of
the Eighth Judicial District Court, County of Clark; Petitioner was ( check one) present in
Proper Person / not present, and Respondent was ( check one) present in Proper Person /
not present, and the Court having reviewed the papers and pleadings on file and the testimony at
the hearing, and the Court being fully advised in the premises, the court finds as follows:
1. Service of the Petition to Terminate Parental Rights and Notice of Hearing was proper.
2. The court has proper jurisdiction over the following children:
Child’s Name Date of Birth Place of Birth (City/State)
3. The children are not known to be Indian children.
© 2017 Family Law Self-Help Center Order to Terminate Parental Rights
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4. The children are not receiving public assistance, or if they are, the Chief of the Child
Enforcement Program of the Division of Welfare and Supportive Services of the Department
of Health and Human Services was properly served and did not oppose the petition.
5. The natural parents of the children are:
(mother’s name) _________________________________________________________ and
(father’s name) __________________________________________________________
6. There is clear and convincing evidence that the best interest of the children would be served
by terminating the parental rights of (name of parent(s) whose rights are terminated)
________________________________________________________________________.
7. There is clear and convincing evidence that the following grounds exist to terminate the
rights of the parent(s) named above:
Abandonment. The parent has abandoned the children, as defined in NRS 128.012, in
that the parent has not provided for the children’s support and has not communicated with
the children in excess of six months.
Neglect. The children are neglected, as defined in NRS 128.014, in that the parent has
failed, neglected, and refused to provide proper food, clothing, shelter, education, medical
care, or other necessary care for the children’s physical, emotional, and emotional needs.
Unfitness. The parent is unfit, as defined in NRS 128.018, in that the parent has failed to
provide the children with proper care, guidance, and support because of the parent’s fault,
habit, or conduct.
Risk of Harm. The children would be at risk of serious physical, mental, or emotional
injury if they were returned to the parent.
Token Efforts. The parent has made only token efforts to care for the children.
Sexual Assault. The child was conceived as a result of a sexual assault for which the
natural parent was convicted.
8. In support of the above, the Court specifically finds: (judge will complete)
© 2017 Family Law Self-Help Center Order to Terminate Parental Rights
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THEREFORE, IT IS HEREBY ORDERED that the Petition to Terminate Parental Rights is
GRANTED. The parental rights of (name of parent(s) whose rights are terminated)
_______________________________________________________ shall be terminated as to the
children named in finding #2. The parent(s) named above is/are judicially deprived of the custody
and control of the children and shall be removed from the children’s birth certificates.
IT IS FURTHER ORDERED that sole legal and sole physical custody of the children is vested
in (name of custodial parent/guardian) ________________________________________________.
IT IS FURTHER ORDERED that ( check one):
The children’s names shall not be changed.
There is clear and compelling evidence that the substantial welfare of the child
necessitates a name change. The children’s names shall be changed as follows:
Child’s Current Name Child’s New Name
IT IS FURTHER ORDERED that this order does not affect the rights of the petitioner to
seek past-due child support, and pursuant to NRS 128.110(1), this order does not affect the
children’s right to inherit from the parent(s) whose rights are terminated, unless the children are later
adopted.
DATED this (day) _____ day of (month) ______________________, 20_____.
__________________________________________
DISTRICT COURT JUDGE
Respectfully submitted by:
(Your signature)
(Your name)
/s/