Approved, SCAO JIS CODE: OTF STATE OF MICHIGAN JUDICIAL CIRCUIT - FAMILY DIVISION FILE NO. ORDER TERMINATING RIGHTS OF FATHER WITHOUT RELEASE OR CONSENT COUNTY In the matter of Full name of child DOB: Judge: , adoptee Bar no. 1. Date of hearing: 2. A petition has been filed to determine the identity of the father and to determine or terminate his parental rights to the child named above, born out of wedlock on to Date Mother who has executed or proposes to execute a release or consent relinquishing her parental rights to the child. who has joined with her husband in a petition for adoption. 3. Notice of this hearing has been given or waived as required by law. 4. The court has received evidence as to the identity and whereabouts of the father. 5. The adoptee is an Indian child as defined in MCR 3.002(12) and the court has considered the application of the Indian Child Welfare Act and the Michigan Indian Family Preservation Act in this matter. THE COURT FINDS that: (If identity of father is known, check 6. If father is not known, check 8.) 6. The father of the child, born out of wedlock, is (check one) . a. He submitted a verified affirmation of his paternity and a denial of his interest in custody of the child. b. He filed a disclaimer of paternity. c. He was served with a notice of intent to release or consent at least 30 days before the expected date of confinement specified in that notice but failed to file an intent to claim paternity either before the expected date of confinement or before the birth of the child. failed to appear. d. He was given proper notice of this hearing and appeared and denied his interest in the custody of the child. e. He cannot be located after reasonable effort was made. He has not provided support for the mother, has not shown any interest in the child, and has not made provision for the child's care for at least 90 days preceding this hearing. f. He appeared and requested custody of the child. The father has not established any custodial relationship with the child or did not provide any support or care for the mother during pregnancy or for either the mother or child after the child's birth. The court inquired into the fitness and the ability of the father to properly care for the child. It would not be in the best interest of the child to grant custody to the father. g. He is deceased. 7. The mother was married to the conception to the date of birth of the child. He is not the father of the child. for part or all of the time from 8. The identity of the father cannot be determined after reasonable effort was made. He has not made provision for the child's care and did not provide support for the mother during her pregnancy or during her confinement. IT IS ORDERED that the parental rights of Date Judge Do not write below this line - For court use only are terminated. American LegalNet, Inc. www.FormsWorkFlow.com PCA 312 (2/15) ORDER TERMINATING RIGHTS OF FATHER WITHOUT RELEASE OR CONSENT MCL 710.36, 25 USC 1901 et seq., MCL 712B.1 et seq.