Fill - Free fillable The following documents must be submitted within 30 (Third Judicial Circuit of Michigan) PDF form

STATE OF MICHIGAN

THIRD JUDICIAL CIRCUIT

COURT

WAYNE COUNTY

DIRECT PLACEMENT

CHECKLIST

FILE #

IN THE MATTER OF:

The following documents must be submitted within 30 days of the Temporary Placement, if the child was not

returned to the birth parent:

 Appearances for all Attorney’s. Must be signed and dated by attorney.

 Fees: Money Order Made Payable to “Wayne County Clerk” - $160.00

 Petition for Direct Placement Adoption (PCA 301a) - (1). Must be signed and dated by petitioners (full signatures)

and attorney or agency representative.

 Adoptee’s Certified Birth Certificate (Birth Verification will be accepted at time of filing, however, a certified copy is

required prior to finalization).

 Follow-Up Report After Temporary Placement of Child for Adoption (PCA 333) - (1). Must be signed and

dated by attorney and/or agency representative.

 Statement of Identifying Information (PCA 340) - (1), if applicable. Must be signed and dated by attorney or agency

representative.

 Petitioner’s Verified Accounting (7-Day) (PCA 347) -(1). Must be signed and dated by petitioners (full signatures).

 Statement of Services Performed By Attorney (7-Day) (PCA 346) -(1). Must be signed and dated by Attorney, if

applicable.

 Statement of Services Performed by Agency (7-Day) (PCA 345) - (1). Must be signed and dated by agency

representative.

 Application for New Michigan Birth Certificate – (2). Must be signed by petitioners (full signatures).

 Notice of Adoptive Family’s Right to Employ Counsel. Must be signed and dated by petitioners (full signatures)

and agency representative. (This is not needed if petitioners are represented by an attorney)

 Indian Child Information, if applicable

 Any Court Orders relevant to the case (ie: Guardianship)

 Notice to Adopting Parents on Pending or Potential Appeal/Rehearing – (PCA 325) – 1). Must be signed by

agency representative, or submitted for court distribution.

 Adoption Database Main Form

 All Preplacement Assessments/Home Studies and any addendums. (Clearances must be updated within

the past 12 months.) – If not previously submitted with Temporary Placement documents.

 Copies of Petitioner’s Birth Certificates, Current and all Prior Marriage Certificates, as well as all prior

Divorce Judgments and or Death Certificates for previous spouses. (copies are acceptable)

 Copies of petitioner’s state issued identification. Social Security cards may be requested if there is a

name discrepancy. If a petitioner was born in another country a copy of their Naturalization or

valid/current Resident Alien Card is required.

 Social History of Birth Parents (Identifying and Non-Identifying Information – See MCL 710.27)

 Medical Report for adoptee and petitioner(s) – must be signed by a physician, within one year.

Electronic signatures are acceptable. Medical information for other family members must be included in

the Preplacement Assessment/Home Study.

 Waiver of Notice of Finalization Hearing signed by all interested parties. NEW

If the putative father’s consent is unobtainable, the following documents are required for the consent and

termination hearing (MCL 710.31 and MCL 710.36).

 Petition for Hearing to Identify Father and Determine or Terminate His Rights (PCA 310) – (1). Must be signed

and dated by biological mother and agency representative.

 Declaration of Inability to Locate Father (PCA 315), if applicable – (1). Must be signed by biological mother and

agency representative.

 Custody Statement of Putative Father (PCA 316), if applicable – (1)

 Notice of Intent to Claim Paternity from the Department of Community Health Clearance

 Notice of Hearing to Identify Father and Determine or Terminate His Rights (PCA 311), if applicable – (1)

 Consent to Adoption By Parent – (PCA 308) - (1).

 Statement to Accompany Consent in Direct Adoption (PCA 339) - (1)

 Advice of Rights After Termination of Parental Rights (Adoption Code) (PCA 323) – (2)

 Parent's/Guardian's Verified Accounting for Adoption Release or Direct Placement Consent (PCA 348) - (1)

 Order Terminating Parental Rights After Release or Consent (PCA 318) (COURT WILL CREATE)

 Order Terminating Rights of Father Without Release or Consent (PCA 312) (COURT WILL CREATE)

 Order Placing Child After Consent - (PCA 320) (COURT WILL CREATE)

 Copy of biological mother’s photo identification

 If the biological parent is a minor, the minor parent’s parent or guardian’s signature is needed on all

documents signed by the minor parent, unless the minor parent has been legally emancipated.

 If the biological parent is a minor, the minor parent’s birth certificate is needed, as well as a copy of the

minor parent’s parent identification.

If both the mother and father are willing to consent, the following documents are required for the consent

hearing. Consents are taken daily on a walk-in basis at 8:30 am. Please contact the Adoptions Coordinator at

(313) 833-1962 to inform the court of the date that the consents are to occur (MCL 710.43).

 Consent to Adoption By Parent – (PCA 308) - (1 per parent)

 Statement to Accompany Consent in Direct Adoption (PCA 339) - (1 per parent)

 Advice of Rights After Termination of Parental Rights (Adoption Code) (PCA 323) – (2 per parent)

 Parent's or Guardian's Verified Accounting for Adoption Release or Direct Placement Consent (PCA 348) -

(1 for mother only)

 Order Terminating Parental Rights After Release or Consent (PCA 318) (COURT WILL CREATE)

 Order Placing Child After Consent - (PCA 320) (COURT WILL CREATE)

 Copy of photo identification for each parent

 If the biological parent is a minor, the minor parent’s parent or guardian’s signature is needed on all

documents signed by the minor parent, unless the minor parent has been legally emancipated.

Use the most recent version of the SCAO approved forms

http://courts.michigan.gov/Administration/SCAO/Forms/Pages/Adoption.aspx

For Court Use Only

DATE

otice of Hearing mailed (certified/restricted) to legal and/or putative father ____________

Case Placed in Supervision for six months ____________

True Copies of PCA 312 or PCA 318, PCA 323, PCA 339 (if applicable)

Support Groups and Pamphlet mailed to legal and/or putative father ____________

True Copies of PCA 318, PCA 323, PCA 339, PCA 348, Support Groups

and Pamphlet mailed to biological mother. ____________

True Copy of Order Placing Child After Consent mailed to the supervising agency ____________

and/or attorney for petitioner(s)

inal Order of Adoption ____________

Other Disposition ____________

Revised 1/2016

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