Approved, SCAO JIS CODE: OTR STATE OF MICHIGAN JUDICIAL CIRCUIT - FAMILY DIVISION FILE NO. ORDER PLACING CHILD AFTER CONSENT COUNTY In the matter of child Full name of child DOB: , adoptee adoptee is an Indian 1. Date of hearing: THE COURT FINDS: Judge: Bar no. 2. A petition for an order of adoption has been filed. The petitioner is married but the spouse did not join in the petition. 3. A report of investigation has been filed and reviewed by the court. Good cause has been shown that the spouse of the petitioner is excused from joining in or consenting to the petition. 4. The best interests of the adoptee will be served by the adoption. 5. The rights of the parent(s) or the person in loco parentis have been terminated. 6. Other: IT IS ORDERED: 7. The adoptee is made a ward of this court for purposes of adoption and placement in the home of the adoptive parent(s), Name(s) , is approved. shall supervise the adoptee in the home and months, until 8. Court agent or employee, child-placing agency, or Michigan Department of Health and Human Services shall make reports to the court regarding the adjustment of the adoptee in the home every the order of adoption is entered. 9. The adoptive parent(s) may consent to all medical, surgical, dental, optical, psychological, educational, and related services provided to the adoptee. 10. Other: Date Judge NOTE: "Absent good cause to the contrary, the . . . preadoptive placement of an Indian child must be in the following order of preference: (1) a member of the child's extended family; (2) a member of the Indian child's tribe; or (3) an Indian family." MCL 712B.23(1). Do not write below this line - For court use only PCA 320 (2/15) ORDER PLACING CHILD AFTER CONSENT American LegalNet, Inc. www.FormsWorkFlow.com MCL 710.51, MCL 710.52, MCL 712B.23