Fillable , adoptee FILE NO. PETITION FOR COUNTY STEPPARENT (Third Judicial Circuit of Michigan)

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, adoptee FILE NO. PETITION FOR COUNTY STEPPARENT (Third Judicial Circuit of Michigan)

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In the matter of
Full name of child
, adoptee
Do not write below this line - For court use only
(See additional page)
PCA 301b (6/18) PETITION FOR STEPPARENT ADOPTION MCL 710.24, MCL 710.51
Approved, SCAO JIS CODE: APF
STATE OF MICHIGAN
JUDICIAL CIRCUIT - FAMILY DIVISION
COUNTY
PETITION FOR
STEPPARENT ADOPTION
FILE NO.
The petitioners are:
Name
Relationship
to Adoptee Address, City, State, Zip
Date and Place
of Birth
Maiden:
Maiden:
1. An action within the jurisdiction of the family division of circuit court involving the family or family members of the minor
has been previously filed in
Court, Case Number
, was
assigned to Judge
, and remains is no longer pending.
2. The adoptee is:
Full name of child (type or print)
Birth date and time
City, county, and state of birth
Current residential address (if known)
3. The adoptee will be my heir at law.
not be changed.
4. The adoptee’s name will be changed to
First Middle Last
.
5. The adoptee’s property is
.
6. The adoptee’s parents are
Father’s name (type or print) Birth date
Mother’s name and maiden name (type or print) Birth date
Address
Address
City, state, zip
City, state, zip
7. The adoptee’s court-appointed guardian and/or conservator is/are (attach copy[ies] of letters of authority)
Name(s) and address(es)
.
8. The other parent has failed to provide support or comply with a support order and failed to visit or contact the adoptee for
a period of 2 years or more. (Attach form PCA 302, Supplemental Petition and Affidavit to Terminate Parental Rights of Noncustodial Parent.)
Petition for Stepparent Adoption (6/18) Page
of
File No.
9. The adoptee is an Indian child as defined in MCR 3.002(12). The identity of the tribe is
Name of tribe, if known
.
I REQUEST:
10. Termination of all existing parental rights inconsistent with the order of adoption, entry of an order approving placement of
the child with me, and entry of an order of adoption with the adoptee’s name recorded as stated in item 4.
11. The adoption be expedited because
.
I declare that the statements above are true to the best of my information, knowledge, and belief.
Attorney signature
Date
Attorney name (type or print) Bar no.
Signature of petitioner
Address
Signature of petitioner
City, state, zip Telephone no.
Petitioner telephone no.
IT IS ORDERED:
12.
Court agent or employee
is directed to fully investigate and
report its findings in writing to this court, within 3 months of this order, in accordance with the provisions of MCL 710.46.
13. The full investigation is waived.
14. The petitioner(s) shall give notice of this petition to the persons prescribed in MCR 3.800(B) in accordance with MCR
3.802(A)(3) and MCR 3.807(B), if applicable (use form PCA 352).
Date
Judge Bar no.
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, adoptee FILE NO. PETITION FOR COUNTY STEPPARENT (Third Judicial Circuit of Michigan)

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Completed 29 July 2020

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