JC-1639, 02/17 Order Concerning Termination of Parental Rights (Involuntary) 24724748.426, 48.427 and 48.43, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 1 of 2 STATE OF WISCONSIN, CIRCUIT COURT, COUNTY IN THE INTEREST OF Name Date of Birth Order Concerning Termination of Parental Rights (Involuntary) Case No. This termination of parental rights hearing was held on [Date] , which is the effective date of this Order. THE COURT FINDS: 1. Notice was given to all those entitled to notice. 2. The provisions of the Indian Child Welfare Act do not apply. An inquiry has been made on the record to each participant in this proceeding as to whether the participant knows or has reason to know that the child is an Indian child. [For an Indian child, use the Indian Child Welfare Act version (IW-1639) of this Order.] 3. The parent(s) are A. Parent #1 Date of birth: B. Parent #2 Date of birth: C. Other possible parent(s): Name: Date of birth: Name: Date of birth: Name: Date of birth: 4. There was no declaration of paternal interest. 5. Name(s) failed to appear at the hearing, and is/are in default. 6. This matter was tried to a jury. the court. The following grounds for termination of the parental rights of were found to exist: Parent #1 Parent #2 abandonment relinquishment continuing need of protection or services continuing parental disability continuing denial of periods of physical placement or visitation child abuse failure to assume parental responsibility incestuous parenthood homicide or solicitation to commit homicide of parent American LegalNet, Inc. www.FormsWorkFlow.com JC-1639, 02/17 Order Concerning Termination of Parental Rights (Involuntary) 24724748.426, 48.427 and 48.43, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 2 of 2 parenthood as a result of sexual assault commission of a felony against a child prior involuntary termination of parental rights to another child 7. Parent #1 Parent #2 is unfit. 8. It is in the best interest of the child that the parental rights of the Parent #1 Parent #2 (s) be terminated after considering the following factors: The The age and health of the child, both at the time of the disposition and, if applicable, at the time the child was removed from the home. Whether the child has substantial relationships with the parent or other family members, and whether it would be harmful to the child to sever these relationships. The wishes of the child. The duration of the separation of the parent from the child. Whether the child will be able to enter into a more stable and permanent family relationship as a result of placements and the results of prior placements. 9. Reasonable efforts to achieve the permanency goal of the permanency plan, including through an out-of-state placement if appropriate, were [Complete one of the following only if there is a permanency plan] made by the department or agency responsible for providing services . not made by the department or agency responsible for providing services. 10. Any parent who has appeared was informed of the provisions of 24724748.432, 48.433 and 48.434, Wis. Stats. 11. Other: 12. The evidence does not warrant the termination of the parental rights of [Name] . THE COURT ORDERS: 1.A. The parental rights of [Name of Parent(s)] is/are terminated. Guardianship, placement and care responsibility, and custody of the child remain with the parent whose rights have not been terminated. are transferred pending adoption to . Other: If guardianship or custody is transferred to an agency, that agency shall be responsible for securing the adoption of the child or establishing the child in a permanent family settinmanency plan was filed. is attached. will be filed within 60 days. The provisions of 24724748.432, 48.433 and 48.434, Wis. Stats., are attached. 1.B. The Petition to Terminate Parental Rights of [Name] is dismissed. 2. Other: THIS IS A FINAL ORDER FOR THE PURPOSE OF APPEAL. American LegalNet, Inc. www.FormsWorkFlow.com