IN THE SUPERIOR COURT FOR THE STATE OF ALASKA AT In the Matter of (use child's initials only): ) ) ) ) ) ) CASE NO. REQUEST FOR REVIEW HEARING ON TERMINATION ORDER CINA Adoption Guardianship A minor under 18 years of age. Date of Birth: I am a person who voluntarily relinquished my parental rights to the minor child named above. I ask the court to: enforce or change or vacate a privilege retained in the termination order because [AS 47.10.089(g)]: vacate the termination order and reinstate my parental rights relating to the minor because [AS 47.10.089(h)] (I understand that I can file this request only if an adoption or legal guardianship decree has not yet been entered.): If you need a court appointed attorney, you must fill out form CP-410, Request for Appointed Lawyer. Date I certify that on I sent copies of this request to: City Clerk: Daytime Phone Number Signature Type or Print Name Mailing Address State & ZIP ORDER IT IS ORDERED that the request for review hearing is DENIED. Good cause for a review hearing has not been demonstrated. GRANTED. A review hearing will be held on a.m./p.m., at I certify that on I sent copies of this order to: at . Judge Date Clerk: Type or Print Name AS 47.10.089(g),(h) American LegalNet, Inc. www.FormsWorkflow.com CN-360 (1/06)(cs) REQUEST FOR REVIEW HEARING ON TERMINATION ORDER