IN THE CIRCUIT COURT OF THE ___________ JUDICIAL CIRCUIT IN AND FOR ___________________ COUNTY, FLORIDA JUVENILE DIVISION In the Interest of ) ) ) ) ) Case No. a child JUDGMENT OF VOLUNTARY TERMINATION OF PARENTAL RIGHTS THIS CAUSE came before this court on Petition for Termination of Parental Rights filed by before the court were: , 20 , for an adjudicatory hearing on the . Present , and the father(s), , executed voluntary surrenders of their parental rights for the minor child(ren) which are accepted by the court without objection. The court has carefully considered the testimony of witnesses, reviewed the exhibits, reviewed the file, heard argument of counsel, and considered recommendations and arguments of all parties. The court finds by clear and convincing evidence that the parents, , have surrendered their parental rights to the minor child(ren) under Florida Statutes § 39.806(1)(a), and that termination of parental rights is in the manifest best interest of the child(ren). The specific facts and findings supporting this decision are as follows: 1. That the mother, and the petition.* 2. That the father, and the petition.* , was was not personally served with the summons The mother, , was was not personally served with the summons 3. That the parents were advised of their right to counsel in all prior dependency court proceedings which they attended. The mother has been represented by legal counsel, , starting on or about , 20 . The father has been represented by legal counsel, , starting on or about , 20 . 4. The mother, , freely, knowingly, voluntarily, and with without advice of legal counsel executed an affidavit and acknowledgment of surrender, consent, and waiver of notice on , 20 , for termination of her parental rights to the minor child(ren), under Florida Statutes § 39.806(1)(a). 5. The father, , freely, knowingly, voluntarily, and with without advice of legal counsel executed an affidavit and acknowledgment of surrender, consent, and waiver of notice on , 20 , for termination of his parental rights to the minor child(ren), under Florida Statutes § 39.806(1)(a). * Service is not required if surrender was signed prior to petition filing. Judgment Of Voluntary Termination Of Parental Rights {8.984} Page 1 of 2 American LegalNet, Inc. www.USCourtForms.com 6.** That at all times relevant to this action the interests of this/these child(ren) has/have been represented by a guardian ad litem. The guardian ad litem, , agrees does not agree that it is in the best interest of the child(ren) for parental rights to be terminated in this cause. THEREFORE, it is ORDERED AND ADJUDGED that: 1. The petition for termination of parental rights is GRANTED. 2. The parental rights of the parents, child, The parental rights of the parents, child, The parental rights of the parents, child, The parental rights of the parents, child, , are terminated. , are terminated. , to the , are terminated. , to the , to the , are terminated. , to the 3. The child(ren), custody of (agency) , is/are hereby placed in the permanent care and for subsequent adoption. , 4. A hearing for the department to provide a plan for permanency for the child(ren) shall be held on 20 , within 30 days of rendering of order, at .m. DONE AND ORDERED on , 20 , in County, Florida. _______________________________________ Circuit Judge Copies furnished to: NOTICE Under section Florida Statutes § 39.815, any child, any parent, guardian ad litem, or legal custodian of any child, any other party to the proceeding who is affected by an order of the court, or the department may appeal to the appropriate District Court of Appeal within the time and in the manner prescribed by the Florida Rules of Appellate Procedure, which is 30 days from the date this order is rendered (filed). ** Guardian ad litem not required in a voluntary surrender. Judgment Of Voluntary Termination Of Parental Rights {8.984} Page 2 of 2 American LegalNet, Inc. www.USCourtForms.com