ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, address and telephone #): FOR COURT USE ONLY STATE BAR NO: ATTORNEY FOR (Name): In Pro Per Yes No SUPERIOR COURT OF CALIFORNIA, COUNTY OF MARIN 3501 Civic Center Drive P.O. Box 4988 San Rafael, CA 94913-4988 IN THE MATTER OF THE PETITION OF: ON BEHALF OF: A CHILD, ORDER DECLARING CHILD FREE FROM PARENTAL CUSTODY AND CONTROL CASE NUMBER: 1. The petition of __________________________________________________ for an order declaring ________________________________, a child, free from the parental control of and terminating the parental rights of ____________________________________, the biological Father/Mother of a child, was heard on _______________________________________________. Petitioner, In Pro Per or Petitioner with attorney ______________________________________________, appeared. 2. Proof has been made to the satisfaction of the court that notice of the hearing of the petition has been regularly given in the manner and for the time required by law. 3. On the testimony of ___________________________________, and other evidence, and the court being advised in the premises, the court has found that the allegations in the Petition are true and good cause appearing therefrom, IT IS HEREBY ORDERED THAT THE CHILD IS FREED FROM THE CUSTODY AND CONTROL OF _________________________________________________. Date: JUDGE OF THE MARIN COUNTY SUPERIOR COURT I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date: . . . . . . . . . . . . . . . . . . . . . . . . . . . . (TYPE OR PRINT NAME) CV024WB ► SIGNATURE OF PERSON COMPLETING THIS FORM ORDER DECLARING CHILD FREE FROM PARENTAL CUSTODY AND CONTROL Rev. 7/07 American LegalNet, Inc. www.FormsWorkflow.com