IN THE COURT OF COMMON PLEAS OF CHESTER COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION IN RE: {use initials only} Case Number: ___________________________ PETITION FOR INVOLUNTARY TERMINATION OF PARENTAL RIGHTS IMPORTANT NOTICE ­ BIRTH PARENT TO: [NAME] [ADDRESS] A petition has been filed asking the Court to put an end to all rights you have to your child _______________________________. The Court has set a hearing to consider ending your rights to your child. That hearing will be held in the Chester County Justice Center, West Chester, Pennsylvania on _____________________, 20______, at _____:_____ am/pm in Courtroom No. ______, before the Honorable _______________________. You are warned that even if you fail to appear at the scheduled hearing, the hearing will go on without you and your rights to your child may be ended by the Court without your being present. You have a right to be represented at the hearing by a lawyer. You should take this paper to your lawyer at once. If you do not have a lawyer or cannot afford one, go to or telephone the office set forth below to find out where you can get legal help. LAWYER REFERRAL SERVICE CHESTER COUNTY BAR ASSOCIATION 15 WEST GAY STREET SECOND FLOOR WEST CHESTER, PENNSYLVANIA 19380 610-429-1500 American LegalNet, Inc. www.FormsWorkFlow.com