Approved, SCAO JIS CODE: DPA STATE OF MICHIGAN PETITION FOR DIRECT PLACEMENT ADOPTION 6th JUDICIAL CIRCUIT - FAMILY DIVISION FILE NO. OAKLAND COUNTY In the matter of , adoptee Full name of child The petitioners are: Name Relationship To Adoptee Name Date and Place Of Birth Address, City, State, Zip Adopting Mother Maiden: Adopting Father Each adopting petitioner states: 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 assigned to Judge , and 2. The adoptee was born on , was remains is no longer pending. at Birth date and time City, county, and state of birth 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 Birth date Mother’s name (and maiden name) Address Address City, state, zip Birth date City, state, zip unknown because the rights of the parents have been terminated by a court of competent jurisdiction and parental rights are vested in . Name and address of court or agency (PLEASE SEE OTHER SIDE) Do not write below this line – For court use only 7. The adoptee’s court-appointed guardian and/or conservator is/are (attach copy(ies) of letters of authority) Name(s) and address(es) PCA 301 (3/10) PETITION FOR ADOPTION MCL 710.24, MCL 710.26, MCL 710.45, MCL 710.46, MCL 710.52, MCL 710.56 American LegalNet, Inc. www.FormsWorkFlow.com 8. The adoptee has been living with the petitioners in their home for months before filing this petition. 9. (applies only to stepparent adoptions) The noncustodial 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) 10. I have been unable to obtain the required consent to adopt the child from the court, Michigan Department of Human Services or child-placing agency having permanent custody or from the persons to whom the child was released. A motion alleging that the decision to withhold consent was arbitrary and capricious is attached. 11 The adoptee is an Indian child as defined in MCR 3.002(5). The identity of the tribe is . Name of the tribe, if known I REQUEST: 12. 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 . 13. The adoption be completed immediately because: 14. The court to waive the required investigation because the adoptee has been placed in foster care with me for at least 12 months and a foster family study was completed or updated within the last 12 months. I declare that this petition has been examined by me and that its contents are true to the best of my information, knowledge, and belief. Attorney/Agency signature Attorney/Agency name (type or print) Date Bar no. Address City, state, zip Signature of petitioner mother Signature of petitioner father Telephone no. Petitioner telephone no. IT IS ORDERED: 15. Palmer L. Sesti, Adoption Supervisor Court agent or employee, child-placing agency, or Michigan Department of Human Services 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 section 46 of the Michigan Adoption Code. 16. The full investigation is waived. The petitioner(s) shall file a copy of the most recent foster family study as updated and supplemented. 17. The petitioners shall give notice of this petition to the persons prescribed in MCR 3.800(B) in accordance with MCR 3.800(B) In accordance with MCR 3.802(A)(3) (use form PCA 352). Judge Bar no. American LegalNet, Inc. www.FormsWorkFlow.com