1. þ In the matter of þ ( en-USname(s), alias(es), DOB) 2. þ On en-USDateen-US an order was entered terminating your parental rights to the child(ren) named above. 3. þ en-USYou have the right to þ a. þ appeal the order terminating your parental rights to the Court of Appeals for the State of Michigan, or file a motion for þ rehearing with this court, within 14 days* after the date of the order terminating your parental rights. þ b. þ an attorney for appeal/rehearing purposes, and if you cannot afford an attorney, the court will appoint one for you. If you þ desire a court-appointed attorney, you must file the request on the other side of this form within 14 days after the date of þ personal service or mailing of service of the order terminating your parental rights or within 14 days after an order denying þ a timely filed postjudgment motion. 4. þ If the court appoints an attorney to perfect your appeal, the court will furnish the attorney with the portions of the transcripts þ and court records the attorney requires for the appeal. 5. þ Your obligation to support the child(ren) continues until a court of competent jurisdiction modifies or terminates the obligation, þ an order of adoption is entered, or the child is emancipated by operation of law. 6. þ en-USIn addition to the above rightsen-US you have the right to control the release of identifying information about yourself under the þ adoption laws of this state as follows: þ a. þ You may file with the Central Adoption Registry of the Michigan Department of Health and Human Services, at any time, þ a form called 223Parent222s Consent/Denial to Release Information to Adult Adoptee.224 With this form (copies available at all þ þ circuit courts or Department of Health and Human Services offices) you can consent to or deny the release of the following þ identifying information: 225 þ þ your name at the time of termination of your parental rights. 225 þ þ your most recent name and address which is on file with the Central Adoption Registry. þ þ You can use this form any time you change your mind about consenting to or denying the release of identifying information. þ b. þ You may keep your name and address current with the Central Adoption Registry by sending this information to them in þ writing. en-USNote:en-US If you do not file a 223Parent222s Consent/Denial to Release Information to Adult Adoptee224, or if you revoke a previously fileden-USdenial, then the identifying information stated in item 6 will be released upon request of each child after reaching the age of 18. If en-USthe other former parent has filed a denial of release of identifying information which has not been revoked, the identifying en-USinformation about that parent will not be released.en-US*Note:en-US An appeal of right must be filed within 14 days of an order terminating parental rights. MCR 7.204(A)(1). An application en-USfor leave to appeal must be filed within 21 days after entry of the order being appealed. MCR 7.205(A)(1). In no event shall an en-USapplication for leave to appeal an order terminating parental rights be granted if filed more than 63 days after entry of an order en-USof judgment on the merits, or if filed more than 63 days after entry of an order denying reconsideration or rehearing. en-USMCR 3.993(C).en-US(Please see other side for en-USRequest for Court-Appointed Attorney) en-USDate of mailing/service American LegalNet, Inc. www.FormsWorkFlow.com Case No. Petition No. en-USREQUEST FOR COURT-APPOINTED ATTORNEYen-USI request a court-appointed attorney to appeal or request a rehearing of the order terminating my parental rights.en-USI am unable to pay for the services of an attorney and request that one be appointed by the court. I have completed theen-USfinancial schedule below. I understand that I may be ordered to repay the court for all or part of the attorney fees. I authorizeen-USthe court to investigate and obtain relevant information from my employer, creditors, and others who have knowledge of myen-USfinancial circumstances for purposes of aiding the court in determining my eligibility for the appointment of an attorney. þ en-USSignature þ en-USName (please print) þ en-USAddress þ en-USCity, state, and zip Telephone no.en-USComplete this Financial Schedule if you are seeking a court-appointed attorney.en-USFINANCIAL SCHEDULE en-US1. RESIDENCE þ Rent þ Own þ Live with parents þ en-US Room/Board en-US2. MARITAL STATUS þ Single þ Married þ Divorced þ Separated þ en-US Dependents: en-USNumberen-US3. INCOME en-US a. Employer name and addressen-USb. Length of employmenten-USc. Average pay þ en-US weekly en-US monthly en-US every two weeksen-USGross: $ en-US en-US Net: $ en-US en-US en-USd. Other income (state monthly amount and source [MDHHS, VA, rent, pensions, spouse, unemployment, child support, etc.])en-US4. ASSETSen-US en-USState value of car, home, bank deposits, bonds, stocks, etc.en-US5. OBLIGATIONSen-US en-USItemize monthly rent, installment payments, mortgage payments, child support, etc.en-US6. REIMBURSEMENTen-US I understand that I may be ordered to reimburse the court for all or part of my attorney and defense costs.en-USI declare under penalty of contempt of court that the above information is true to the best of my information, knowledge, anden-USbelief. en-USDate þ en-USSignature American LegalNet, Inc. www.FormsWorkFlow.com