Approved, SCAO STATE OF MICHIGAN JUDICIAL CIRCUIT - FAMILY DIVISION COUNTY Court address MOTION AND AUTHORIZATION/DENIAL CASE NO. PETITION NO. Court telephone no. 1. In the matter of (name(s), alias(es), DOB) MOTION 2. The names and addresses of parents, guardians, or legal custodians are: Father Mother Guardian/Legal custodian Address Address Address 3. I request a transfer of this case to the formal calendar review. hearing regarding the agency's notice of intent to return the child home. review the initial services plan and/or custody or placement order. State reasons below as appropriate rehearing. adjournment. I declare that this motion has been examined by me and that its contents are true to the best of my information, knowledge, and belief. Agency/Address City, state, and zip Telephone no. Signature Name (type or print) Date AUTHORIZATION/DENIAL 4. Transfer is authorized and hearing on the petition of Date is set for at m. at Time Location . is authorized and . Location Date 5. Review Rehearing Date Adjournment Hearing on agency's intent to return child home at Time hearing is set for 6. Transfer Review Rehearing m. at is denied. Adjournment Date Judge/Referee Bar no. Do not write below this line - For court use only JC 15 (9/15) MOTION AND AUTHORIZATION / DENIAL MCL 712A.13a(14), MCL 712A.17, MCL 712A.18d, MCL 712A.19(10), MCL 712A.21, MCR 3.923(G), MCR 3.932(C)(8), MCR 3.942(A), MCR 3.945(A), MCR 3.966, MCR 3.972(A), MCR 3.975(H), MCR 3.992(A) American LegalNet, Inc. www.FormsWorkFlow.com