ORDER, TERMINATION OF PARENTAL RIGHTS AND APPOINTMENT OF STATUTORY PARENT/GUARDIAN JD-JM-31 Rev. 4-18 C.G.S. 247247 17a-42(b), 17a-111b, 17a-112, 45a-715, 45a-717(f), (g), (h), (k); P.B. 247 35a-19(a)STATE OF CONNECTICUT SUPERIOR COURT JUVENILE MATTERS www.jud.ct.gov Address of court Docket number Name of petitioner Name of child Date of birth Name of father Address of father Name of mother Address of mother Name of guardian (If applicable) 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 mother and/or father named above in the child be terminated in conformity with the provisions of the Connecticut General Statutes and that a statutory parent or guardian be appointed, the court finds clear and convincing evidence that:I. DCF has made reasonable efforts to locate the mother father (if applicable). DCF has made reasonable efforts to reunify the child with the mother father; or Mother Father is/are unable or unwilling to benefit from reunification efforts. Reasonable efforts to reunify are not required for mother father as the court determined at a hearingin accordance with Section 17a-111b of the Connecticut General Statutes or determined at a trial on the petition that such efforts are not required. Reasonable efforts to reunify are not required for mother father because the court has approved a permanency plan other than reunification in accordance with Section 17a-111b of the Connecticut General Statutes.Il. The court finds clear and convincing evidence of the following ground(s) for termination of parental rights: The mother father of said child voluntarily and knowingly consent(s) to the termination of any parental rights with respect to the child; or A. The child has been abandoned by the mother father in the sense that the parent(s) failed tomaintain a reasonable degree of interest, concern or responsibility as to the welfare of the child. B1. The child has been found in a prior proceeding to have been neglected, abused or uncared for AND the mother father has/have failed to achieve such degree of personal rehabilitation as would encourage the belief that within a reasonable time, considering the age and needs of the child, he/she/they could assume a responsible position in the life of the child; or B2. The child is neglected, abused or uncared for, 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 AND the father has/have failed to achieve such degree of personal rehabilitation as would encourage the belief that within a reasonable time, considering the age and needs of the child, he/she/they could assume a responsible position in the life of the child. mother C. The child has been denied, by reason of an act or acts of parental commission or omission, including, but not limited to, sexual molestation or exploitation, severe physical abuse or a pattern of abuse, by the mother father the care, guidance or control necessary for his or her physical, educational, moral or emotional well-being. D. There is no ongoing parent-child relationship with respect to the mother father that ordinarily developsas a result of a parent having met on a day-to-day basis the physical, emotional, moral and educational needs of the child and to allow further time for the establishment or reestablishment of the parent-child relationship would be detrimental to the best interests of the child.(Continued) American LegalNet, Inc. www.FormsWorkFlow.com E. The mother father of the child, under the age of seven years who is neglected, abused or uncared for has/have failed, is/are unable, or is/are unwilling to achieve such degree of personal rehabilitation as 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 in accordance with a petition filed by the Commissioner of Children and Families. F. The father has killed through deliberate, nonaccidental act another child of the parent or has motherrequested, commanded, importuned, attempted, conspired or solicited such killing or has committed an assault, through deliberate, nonaccidental act that resulted in serious bodily injury of another child of the parent. G. The mother father committed an act that constitutes sexual assault as described in Section 53a-70,53a-70a, 53a-70c, 53a-71, 53a-72a, 53a-72b or 53a-73a of the Connecticut General Statutes or compelling a spouse or cohabitor to engage in sexual intercourse by the use of force or by the threat of the use of force as described in Section 53a-70b, if such act resulted in the conception of the child.III. The court finds clear and convincing evidence that termination of parental rights is in the best interest of thechild.OrderIt is therefore ordered that the parental rights of the mother father named above in the child are terminated inaccordance with the Connecticut General Statutes.1. The statutory parent for the child shall be the Commissioner of Children and Families,or The guardian of the person of the child shall be (Name and address): 2.The statutory parent or guardian shall file a case plan not later than 30 days after date of judgmentand at least every three months thereafter shall file a report or treatment plan/administrative reviewon the implementation of the plan. Case plan due date3.A hearing to review the permanency plan shall be convened and conducted not more than 12 monthsfrom 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 remains in the custody of the Commissioner ofChildren and Families. Hearing date4. The court approves the cooperative postadoption agreement attached hereto and made a part hereof.5. The Commissioner of Children and Families shall place the child on the photo-list within 30 days of thetermination 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 Clerkof the Superior Court for Juvenile Matters at (location) of thedate when the adoption is finalized. Name of Judge Signed (Judge) Date of orderThe above and foregoing is a true copy of the order and was provided to the Commissioner of Children and Families and(if applicable) to the Probate Court at: . Signed (Judge, Clerk) At (Town) On (Date) JD-JM-31 (back) Rev. 4-18 American LegalNet, Inc. www.FormsWorkFlow.com