Approved, SCAO JIS CODE: SPT STATE OF MICHIGAN JUDICIAL CIRCUIT - FAMILY DIVISION COUNTY In the matter of FILE NO. SUPPLEMENTAL PETITION AND AFFIDAVIT TO TERMINATE PARENTAL RIGHTS OF NONCUSTODIAL PARENT DOB: Full name of child , adoptee SUPPLEMENTAL PETITION I, , am the custodial parent of the child named above, and I request Name (type or print) that the parental rights of , the noncustodial parent of the child, be Name (type or print) terminated because of lack of support of and parenting time with the child. Date Custodial parent signature AFFIDAVIT 1. I have joined in a petition with on , whom I married Name (type or print) , requesting the adoption of the child named above and the termination of the Date parental rights of the noncustodial parent named above. 2. The noncustodial parent and I were divorced on . A copy of the judgment of Date divorce and any subsequent orders are attached and filed with the court. 3. The noncustodial parent acknowledged paternity on Date . A copy of the acknowledgment of paternity is attached and filed with the court. 4. I have legal custody of the child. 5. a. A support order has been entered and the noncustodial parent has failed to substantially comply with the order for a period of two years or more before the petition for adoption was filed. b. A support order has not been entered and the noncustodial parent, having the ability to support the child, has failed or neglected to provide regular and substantial support for two years or more before the petition for adoption was filed. 6. The noncustodial parent has had the ability to visit, contact, and communicate with the child and has regularly and substantially failed or neglected to do so for a period of two years or more before the petition for adoption was filed. (PLEASE SEE OTHER SIDE) Do not write below this line - For court use only PCA 302 (11/05) SUPPLEMENTAL PETITION AND AFFIDAVIT TO TERMINATE PARENTAL RIGHTS OF NONCUSTODIAL MCL 710.26, MCL 710.51(6), MCR 3.801 PARENT American LegalNet, Inc. www.FormsWorkflow.com 7. The last known address of the noncustodial parent is 8. a. The noncustodial parent is living at the above address. b. The noncustodial parent is not living at the above address, and I have taken the following steps to locate him/her. Attorney signature Date Attorney name (type or print) Bar no. Address Address City, state, zip Telephone no. Subscribed and sworn to before me on My commission expires: Signature of custodial parent petitioner Date Date City, state, zip , Signature: Telephone no. County, Michigan. Notary public/Deputy clerk Notary public, State of Michigan, County of American LegalNet, Inc. www.FormsWorkflow.com