Approved, SCAO JIS CODE: OTR CASE NO. STATE OF MICHIGAN 6th JUDICIAL CIRCUIT - FAMILY DIVISION ORDER PLACING CHILD AFTER CONSENT OAKLAND COUNTY In the matter of DOB: , adoptee Full name of child adoptee is an Indian child 1. Date of hearing: Judge: Bar no. THE COURT FINDS: 2. A petition for an order of adoption has been filed. 3. A report of investigation has been filed and reviewed by the court. 4. The best interests of the adoptee will be served by the adoption. 5. The rights of both parents or the person in loco parentis have been terminated. 6. Other: IT IS ORDERED: 7. The adoptee is made a ward of this court for purposes of adoption and placement in the home of the adoptive parents, , is approved. Name(s) 8. shall supervise the adoptee in the home and Court agent or employee, child-placing agency, or Michigan Department of Human Services shall make reports to the court regarding the adjustment of the adoptee in the home every 9. months. The adoptive parent(s) may consent to all medical, surgical, dental, optical, psychological, educational, and related services provided to the adoptee. Date Judge NOTE: “In any adoptive placement of an Indian child under State law, a preference shall be given, in the absence of good cause to the contrary, to a placement with (1) a member of the child’s extended family; (2) other members of the Indian child’s tribe; or (3) other Indian families,” 25 USC 1915(a) Do not write below this line - For court use only PCA 320 (3/10) ORDER PLACING CHILD AFTER CONSENT 25 USC 1915(a), MCL 710,51, MCL 710.52 American LegalNet, Inc. www.FormsWorkFlow.com