Approved, SCAO JIS CODE: NOH STATE OF MICHIGAN th FILE NO. 6 CIRCUIT COURT – FAMILY DIVISION OAKLAND COUNTY PETITION FOR HEARING TO IDENTIFY FATHER AND DETERMINE OR TERMINATE HIS RIGHTS In the matter of , adoptee Full name of child 1. I am the mother of the adoptee named above who was born out of wedlock on at Date . The adoptee resides at City, county, and state Address 2. City State Zip An action within the jurisdiction of the family division of circuit court involving the family or family members of the minor has been previously filed in Court, Case Number assigned tp Judge , and release consent , was remains 3. I plan to sign a 4. pending. I have joined with my husband in a petition for adoption. 5. is no longer giving up my parental rights to the child. The child is an Indian child as defined in MCR 3.002(5). The identity of the tribe is . Name of tribe, if known 6. The putative father of my child is Name (type or print) Address 7. Birthdate (if unknown, state if over 18 years old . State Zip City For part or all of the time from conception to the date the child was born, I was married to Name (type or print) whose last-known address is . He is not the father of the child. 8. I request the court to hold a hearing to determine the identity of the father of my child and to determine or terminate his parental rights. I declare that this petition has been examined by me and that its contents are true to the best of my information, knowledge, and belief. Date Attorney name Bar no. Address City, state, zip Petitioner name Address Telephone no. City, state, zip Telephone no. Do not write below this line – For court use only MCL 710.22(d), MCL 710.36, MCR 3.801, MCR 3.801 PCA 310 (3/10) PETITION FOR HEARING TO IDENTIFY FATHER AND DETERMINE OR TERMINATE HIS RIGHTS American LegalNet, Inc. www.FormsWorkFlow.com