Release Of Child By Child Placing Agency
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Release Of Child By Child Placing Agency Form. This is a Michigan form and can be use in Adoption Statewide.
Tags: Release Of Child By Child Placing Agency, PCA 306, Michigan Statewide, Adoption
JIS CODE: RAG
Approved, SCAO
FILE NO.
STATE OF MICHIGAN
RELEASE OF CHILD BY
CHILD PLACING AGENCY
JUDICIAL CIRCUIT - FAMILY DIVISION
COUNTY
In the matter of
DOB:
, adoptee
Full name of child
I,
, on behalf of
Name of representative
Name of child placing agency
voluntarily release and relinquish parental rights to the child named above to the Michigan Department of Human Services for the
purpose of adoption or suitable placement. I am the duly authorized representative of the child placing agency.
Signature
Title
Subscribed and sworn to before me on
My commission expires:
in
Date
Signature:
Date
County, Michigan.
Notary public
Notary public, State of Michigan, County of
Do not write below this line - For court use only
PCA 306 (11/05)
RELEASE OF CHILD BY CHILD PLACING AGENCY
MCL 710.28, MCL 710.29, MCR 3.801
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