In the matter of Full name of child , adoptee � Approved, SCAO � JIS CODE: APFSTATE OF MICHIGANJUDICIAL CIRCUIT - FAMILY DIVISIONCOUNTY PETITION FOR ADOPTION Related Within 5th Degree Other (Excluding Direct Adoption)FILE NO. en-USThe petitioners are: en-USNameen-USRelationshipen-USto Adopteeen-USAddress, City, State, Zipen-USDate and Placeen-USof Birth en-US Adopting parenten-USMaiden: en-US Adopting parenten-USMaiden:en-USEach adopting petitioner states: � 1. � 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 en-US en-US Court, Case Number en-US en-US , was � assigned to Judge en-US , and � remains � is no longer � pending. 2. � I desire to adopt: en-USFull name of child (type or print)en-US en-USBirth date and timeen-US en-USCity, county, and state of birth � � en-USCurrent residential address (if known) 3. � The adoptee will be my heir at law. � en-US not be changed. 4. � The adoptee222s name will � en-US be changed to en-USFirst Middle Lasten-US . 5. � The adoptee222s property is en-US en-US . 6. � � a. � The adoptee222s parents are � en-USFather222s name (type or print) Birth date � en-USMother222s name and maiden name (type or print) Birth date � en-USAddress � en-USAddress � en-USCity, state, zip � en-USCity, state, zip � � b. � The rights of the parents have been terminated by a court of competent jurisdiction and parental rights are vested in � � en-USName and address of court or agencyen-US . American LegalNet, Inc. www.FormsWorkFlow.com Petition for Adoption � (6/18) � Page of File No. � 7. � The adoptee222s court-appointed guardian and/or conservator is/are en-US(attach copy[ies] of letters of authority) � en-USName(s) and address(es)en-US . � en-US � 8. � The adoptee has been living with the petitioners in their home for en-US en-US months before filing this petition. � 9. � I have been unable to obtain the required consent to adopt the child from the court, Michigan Department of Health and � Human Services or child-placing agency having permanent custody, or from the persons to whom the child was released. � A motion alleging that the decision to withhold consent was arbitrary and capricious is attached. � 10. � I am married but my spouse is not joining me in this petition because: en-US(Attach separate sheet as needed.) � 11. � The adoptee is an Indian child as defined in MCR 3.002(12). The identity of the tribe is � � en-USName of tribe, if knownen-US .en-USI REQUEST: 12. � Termination of all existing parental rights inconsistent with the order of adoption, entry of an order approving placement of � the child with me, and entry of an order of adoption with the adoptee222s name recorded as stated in item 4. � 13. � The adoption be completed immediately because en-US � � en-US en-US . � 14. � The court to waive the required investigation because the adoptee has been placed in foster care with me for at least 12 � months and a foster family study was completed or updated within the last 12 months. en-USI declare that the statements above are true to the best of my information, knowledge, and belief. en-USAttorney signature � en-USDate en-USAttorney name (type or print) Bar no. � en-USSignature of petitioner en-USAddress � en-USSignature of petitioner en-USCity, state, zip Telephone no. � en-USPetitioner telephone no.en-USAgency Contact Information: en-USName of agency representative (type or print) � en-USAddress en-USAgency name � en-USCity, state, zip en-USTelephone no.en-US en-USE-mail American LegalNet, Inc. www.FormsWorkFlow.com Petition for Adoption � (6/18) � Page of File No. en-USIT IS ORDERED: � 15. � en-USCourt agent or employee, child-placing agency, or Michigan Department of Health and Human Servicesen-US is directed to fully investigate and � report its findings in writing to this court, within 3 months of this order, in accordance with the provisions of MCL 710.46. � 16. � The full investigation is waived. The petitioner(s) shall file a copy of the most recent foster family study as updated and � supplemented. � 17. � The petitioner(s) shall give notice of this petition to the persons prescribed in MCR 3.800(B) in accordance with MCR � 3.802(A)(3) and MCR 3.807(B), if applicable en-US(use form PCA 352)en-US. en-USDate � en-USJudge Bar no. American LegalNet, Inc. www.FormsWorkFlow.com