ORDER, CO-TERMINATION OF PARENTAL RIGHTS AND APPOINTMENT OF STATUTORY PARENT/GUARDIAN STATE OF CONNECTICUT SUPERIOR COURT JUVENILE MATTERS www jud.ct.gov JD-JM-31A Rev. 10-12 C.G.S. §§ 17a-42(b), 17a-111b, 17a-112, 45a-715, 45a-717(f), (g), (h), (k); PA 12-82, Sec. 16; Pr. Bk. Secs. 35a-3, 35a-19(a) Address of Court Docket number Name of petitioner Name of child/youth Name of father Address of father Name of mother Address of mother Name of guardian (If applicable) Date of birth Address of guardian (If applicable) At a session of the Superior Court upon notice and hearing on the petition by the party indicated above, requesting that the parental rights of the above-named mother and/or father in the child or youth be terminated in accordance with the provisions of the Connecticut General Statutes and that a statutory parent or guardian be appointed, the court finds by a fair preponderance of the evidence that said child or youth is: Neglected Uncared for Abused and I. Continuation in the home is contrary to the welfare of said child/youth and: Reasonable efforts to prevent or eliminate the need for removal of the child or youth were made by the state. Reasonable efforts to prevent or eliminate the need for removal of the child or youth from the home were not possible. Reasonable efforts were not made. Voluntary placement — such out-of-home placement — is in the best interest of the child or youth. II. There is clear and convincing evidence that: DCF has made reasonable efforts to locate the mother DCF has made reasonable efforts to reunify the child or youth with the Mother Father father (if applicable). mother father, or is/are unable or unwilling to benefit from reunification efforts. Reasonable efforts to reunify are not required for mother father because the court determined at a hearing in accordance with Section 17a-111b of the Connecticut General Statutes or determined at a trial on the petition that such efforts are not required. III. The court finds clear and convincing evidence of the following ground(s) for termination of parental rights: The mother father of the child or youth voluntarily and knowingly consents to the termination of any parental rights with respect to the child or youth; or A. The child or youth has been abandoned by the mother father in the sense that the parent(s) failed to maintain a reasonable degree of interest, concern, or responsibility as to the welfare of the child or youth. B1. The child or youth has been found in a prior proceeding to have been neglected, uncared for or abused AND mother father has/have failed to achieve such degree of personal rehabilitation they would encourage the belief that within a reasonable time, considering the age and needs of the child or youth, he/she/they could assume a responsible position in the life of the child or youth, or B2. The child or youth is neglected, uncared for, or abused and has been in the custody of the Commissioner for at least 15 months and the parent has been provided specific steps to take to facilitate the return of the child or youth mother father has/have failed to achieve such degree of personal rehabilitation that would AND the encourage the belief that within a reasonable time, considering the age and needs of the child or youth, he/she/ they could assume a responsible position in the life of the child or youth. (Continued) American LegalNet, Inc. www.FormsWorkFlow.com C. The child or youth has been denied, by reason of an act or acts of commission or omission, including but not limited mother father to, sexual molestation or exploitation, severe physical abuse or a pattern of abuse, by the the care, guidance or control necessary for his or her physical, educational, moral or emotional well being. D. There is no ongoing parent-child or parent-youth relationship with respect to the mother father that ordinarily develops as a result of a parent having met on a day-to-day basis the physical, emotional, moral, and educational needs of the child or youth and to allow further time for the establishment or re-establishment of the parent-child parent-youth relationship would be detrimental to the best interests of the child or youth. E. The mother father of the child, under the age of seven years who is neglected, uncared for or abused has/have failed, is/are unable or is/are unwilling to achieve such degree of personal rehabilitation that would encourage the belief that within a reasonable period of time, considering the age and needs of the child, such parent(s) could assume a responsible position in the life of the child and such parent's/parents' parental rights of another child were previously terminated pursuant to a petition filed by the Commissioner of the Department of Children and Families. F. The mother father has killed through deliberate, non-accidental act another child or youth of the parent or has requested, commanded, importuned, attempted, conspired, or solicited such killing or has committed an assault, through deliberate non-accidental act that resulted in serious bodily injury of another child or youth of the parent. G. The mother father was convicted as an adult or a delinquent by a court of competent jurisdiction of a sexual assault resulting in the conception of the child/youth, except a conviction for a violation of section 53a-71 OR 53a-73a of the Connecticut General Statutes. IV. The court finds clear and convincing evidence that termination of parental rights is in the best interest of the child or youth. Order mother It is therefore ordered that the parental rights of the father named above in the child or youth be and are terminated in accordance with the Connecticut General Statutes. 1. The statutory parent for the child or youth shall be the Commissioner of the Department of Children and Families, Or The guardian of the person of the child or youth shall be (Name and address): 2. The statutory parent or guardian shall file a case plan not later than (30 days after date of judgment): and at least every three months thereafter shall file a report or treatment plan/administrative review on the implementation of the plan. Case plan due date Hearing date 3. A hearing to review the permanency plan shall be convened and conducted no more than 12 months from the date of judgment or from the date of the last permanency plan hearing, whichever is earlier, and at least once a year thereafter while the child or youth remains in the custody of the Commissioner of Children and Families. 4. The court approves the cooperative post-adoption agreement attached hereto and made a part hereof. 5. The Department of Children and Families shall place the child on the photo-list within 30 days of the termination of parental rights. 6. If an adoption occurs in the Probate Court, the Clerk of the Probate Court shall notify in writing the Deputy Chief Clerk of the Superior Court for Juvenile Matters at (location) of the date when the adoption is finalized. Name of Judge Signed (Judge) Date of Order Date signed The above and foregoing is a true copy of the order and was mailed to the Commissioner of Children and Families and . (if applicable) to the Probate Court at: Signed (Judge, Clerk) At (Town) On (Date) JD-JM-31A (back) Rev. 10-12 American LegalNet, Inc. www.FormsWorkFlow.com