IN THE CIRCUIT COURT OF THE ___________ JUDICIAL CIRCUIT IN AND FOR ___________________ COUNTY, FLORIDA JUVENILE DIVISION In the Interest of a child ) ) ) ) ) Case No. PETITION FOR TERMINATION OF PARENTAL RIGHTS Petitioner, , respectfully petitions this Court for termination of parental rights and permanent commitment of the minor child(ren), , to (agency name) for the purpose of subsequent adoption, and as grounds states the following: A. PARTIES 1. The child, (city, county, state) of this petition, the child is (age) incorporated as Petitioner’s Exhibit The child, (city, county, state) filing of this petition, the child is (age) incorporated as Petitioner’s Exhibit The child, (city, county, state) filing of this petition, the child is (age) incorporated as Petitioner’s Exhibit The child, (city, county, state) filing of this petition, the child is (age) incorporated as Petitioner’s Exhibit , at . At the time of the filing . A copy of the child’s birth certificate is attached to this Petition and . , is a male female child born on , is a male female child born on , at . At the time of the . A copy of the child’s birth certificate is attached to this Petition and . , is a male female child born on , is a male female child born on , at . At the time of the . A copy of the child’s birth certificate is attached to this Petition and . , at . At the time of the . A copy of the child’s birth certificate is attached to this Petition and . 2. The child(ren) is/are presently in the care and custody of in County, Florida. , and is/are residing 3. An affidavit under the Uniform Child Custody Jurisdiction and Enforcement Act is attached to this as Petitioner’s Exhibit . 4. The natural mother of the child(ren) is Petition For Termination Of Parental Rights (Based On Voluntary Relinquishment) {8.980} , who resides at . Page 1 of 4 American LegalNet, Inc. www.FormsWorkflow.com 5. The The The The natural alleged is natural natural natural 6. A guardian ad litem putative father of the child(ren) , who resides at . alleged is putative father of the child(ren) alleged is putative father of the child(ren) alleged is putative father of the child(ren) has , who resides at . , who resides at . , who resides at . has not been appointed to represent the interests of the child(ren) in this cause. B. GROUNDS FOR TERMINATION 1. The parent(s) have been advised of their right to legal counsel at all hearings that they attended. 2. 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, , under Florida Statutes § 39.806(1)(a). without The mother, , freely, knowingly, voluntarily, and with 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, , under Florida Statutes § 39.806(1)(a). 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, , under Florida Statutes § 39.806(1)(a). without The mother, , freely, knowingly, voluntarily, and with 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, , under Florida Statutes § 39.806(1)(a). 2. 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, , under Florida Statutes § 39.806(1)(a). The father, , freely, knowingly, voluntarily, and Petition For Termination Of Parental Rights (Based On Voluntary Relinquishment) {8.980} with without Page 2 of 4 American LegalNet, Inc. www.FormsWorkflow.com 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, , under Florida Statutes § 39.806(1)(a). 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, , under Florida Statutes § 39.806(1)(a). 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, , under Florida Statutes § 39.806(1)(a). 4. Under the provisions of Florida Statutes, chapter 39, it is in the manifest best interest of the child(ren) for parental rights to be terminated for the following reasons: allegations which correspond to Florida Statutes §§ 39.810(1)–(11). 5. A copy of this petition shall be served on the natural mother, father(s), ; and the guardian ad litem, ; the ; the custodian, . 6. This petition is filed in good faith and under oath. WHEREFORE, the petitioner respectfully requests that this court grant this petition; find that the parents have voluntarily surrendered their parental rights to the minor child(ren); find that termination of parental rights is in the manifest best interests of this/these child(ren); and that this court enter an order permanently committing this/these for subsequent adoption. child(ren) to the (name) _______________________________________ Petitioner _______________________________________ Address _______________________________________ VERIFICATION STATE OF FLORIDA COUNTY OF Before me, the undersigned authority, personally appeared , who, being sworn, says is filed in good faith and on information, knowledge, and Petition For Termination Of Parental Rights (Based On Voluntary Relinquishment) {8.980} Page 3 of 4 American LegalNet, Inc. www.FormsWorkflow.com belief is true. Sworn to and subscribed before me on , 20 . ______________________________________ (Title) Attorney’s name Attorney’s address Attorney’s telephone number Florida Bar number CERTIFICATE OF SERVICE I certify that a copy of (document) by U.S. mail hand delivery has been furnished to the following: fax on , 20 . _____________________________________ (Title) Petition For Termination Of Parental Rights (Based On Voluntary Relinquishment) {8.980} Page 4 of 4 American LegalNet, Inc. www.FormsWorkflow.com