IN THE CIRCUIT COURT OF THE ______________________ JUDICIAL CIRCUIT IN AND FOR _______________________________ COUNTY, FLORIDA JUVENILE DIVISION In the Interest of ) ) ) children ) a child Case No. ORDER OF ADJUDICATION AND JUDGMENT OF INVOLUNTARY TERMINATION OF PARENTAL RIGHTS THIS CAUSE came before this court on filed by , 20 for adjudication of the Petition For Dependency . Present before the court were: (check appropriate box and list corresponding name) , Petitioner , Attorney for Petitioner , Attorney for department , Department caseworker , Child , Child , Child , Child , Attorney for child(ren) , Mother , Attorney for mother , Father of (child): , Attorney for father , Guardian ad litem , Attorney for guardian ad litem , Legal custodian , Attorney for legal custodian , Other: The court has carefully considered and weighed the testimony of all witnesses. The court has received and reviewed all exhibits. The court finds that the parent(s), , has/have (list grounds proved) , under Florida Statutes chapter 39. The grounds were proved by clear and convincing evidence. Further, the court finds that termination of parental rights of the parent(s), , is clearly in the manifest best interests of the child(ren). The findings of fact and conclusions of law supporting this decision are as follows: 1. At all stages of these proceedings the parent(s) was/were advised of his/her/their right to legal counsel, or was/were in fact represented by counsel. 2. On or about (date(s)) dependency or TPR, if filed directly): , the following occurred (acts which were basis for 3. The mother has (grounds for TPR) Order of Adjudication And Judgment of Involuntary Termination of Parental Rights {8.983} the Page 1 of 4 American LegalNet, Inc. www.FormsWorkflow.com minor child(ren) within the meaning and intent of Florida Statutes, § 39.806, in that (findings that form the statutory basis for grounds): 4. The father has (grounds for TPR) the minor child(ren) within the meaning and intent of Florida Statutes, § 39.806, in that (findings that form the statutory basis for grounds): 5. The minor child(ren) to whom (parent’s(s’) name(s)) parental rights are being terminated are at substantial risk of significant harm. Termination of parental rights is the least restrictive means to protect the child(ren) from harm. 6. Under the provisions of Florida Statutes §§ 39.806 (1)–(11), it is in the manifest best interests of the child(ren) for parental rights of to be terminated for the following reasons: (a) Regarding any suitable permanent custody arrangement with a relative of the child, the court finds . (b) Regarding the ability and disposition of the parent or parents to provide the child with food, clothing, medical care, or other remedial care recognized and permitted under state law instead of medical care, and other material needs of the child, the court finds . (c) Regarding the capacity of the parent or parents to care for the child to the extent that the child’s safety, wellbeing, and physical, mental, and emotional health will not be endangered upon the child’s return home, the court finds . (d) Regarding the present mental and physical health needs of the child and such future needs of the child to the extent that such future needs can be ascertained based on the present condition of the child, the court finds . (e) Regarding the love, affection, and other emotional ties existing between the child and the child’s parent or parents, siblings, and other relatives, and the degree of harm to the child that would arise from the termination of parental rights and duties, the court finds . (f) Regarding the likelihood of an older child remaining in long-term foster care upon termination of parental rights, due to emotional or behavioral problems or any special needs of the child, the court finds . (g) Regarding the child’s ability to form a significant relationship with a parental substitute and the likelihood that the child will enter into a more stable and permanent family relationship as a result of permanent termination of parental rights and duties, the court finds . (h) Regarding the length of time that the child has lived in a stable, satisfactory environment and the desirability of maintaining continuity, the court finds . (i) Regarding the depth of the relationship existing between the child and present custodian, the court finds Order Of Adjudication and Judgment of Involuntary Termination of Parental Rights {8.983} Page 2 of 4 American LegalNet, Inc. www.FormsWorkflow.com . (j) Regarding the reasonable preferences and wishes of the child, if the court deems the child to be of sufficient intelligence, understanding, and experience to express a preference, the court finds . (k) Regarding the recommendations for the child provided by the child’s guardian ad litem or the legal representative, the court finds . (l) Regarding other relevant factors including the court finds , . 7. Under section 39.811(6)( rights are being terminated) ), Florida Statutes, the court terminates the parental rights of only (parent whose as to the minor child(ren), (child(ren)’s name(s)) . Specifically, the court finds that (specific findings of fact under section 39.811(6), Florida Statutes) . 8. Under sections 39.509(5) and 39.811(7)(a), Florida Statutes, the court finds that continued grandparental visitation is not in the best interests of the child(ren) or that such visitation would interfere with the permanency goals for the child(ren) for the following reasons . 9. Under section 39.811(7)(b), Florida Statutes, the court finds that although parental rights are being terminated, the best interests of (names of child(ren) to which this provision applies) support continued communication or contact by (names of parents, siblings, or relatives of the parent whose rights are terminated and to which this provision applies) except as provided above. The nature and frequency of the communication or contact shall be as follows . It may be reviewed on motion of any party or an identified prospective adoptive parent. THEREFORE, after weighing the credibility of the witnesses, weighing all statutory factors, and based on the findings of fact and conclusions of law above, the court hereby ORDERS AND ADJUDGES THAT: 1. The petition filed by 2. The parental rights of the father, to the child, is granted as to the parent(s), . , and of the mother, , , and of the mother, , , and of the mother, , , are hereby terminated. The parental rights of the father, to the child, , are hereby terminated. The parental rights of the father, to the child, , are hereby terminated. Order Of Adjudication and Judgment of Involuntary Termination of Parental Rights {8.983} Page 3 of 4 American LegalNet, Inc. www.FormsWorkflow.com The parental rights of the father, to the child, , and of the mother, , , are hereby terminated. 3. Under sections 39.811(2) and (5), Florida Statutes, the child(ren), , is/are placed in the custody of (agency) purpose of subsequent adoption. for the 4. The 30-day permanency plan required by Florida Statutes §39.8011(8), shall be filed and heard at on , 20 , at (location) . DONE AND ORDERED on , 20 , at .m., , Florida. Circuit Judge 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). Copies to: Order Of Adjudication and Judgment of Involuntary Termination of Parental Rights {8.983} Page 4 of 4 American LegalNet, Inc. www.FormsWorkflow.com