Approved, SCAOJIS CODE: PETSTATE OF MICHIGANJUDICIAL CIRCUIT - FAMILY DIVISIONCOUNTY PETITION(CHILD PROTECTIVE PROCEEDINGS) en-US Amended þ en-US Supplementalen-USCASE NO.en-USPETITION NO.en-USCourt addressen-USCourt telephone no. 1. þ In the matter of en-US(State the name, county of legal residence, race, sex, and date and place of birth of each child, and indicate with whom the child lives.) en-USa. Name of child and county of legal residenceen-USRaceen-USSexen-USDate and place of birth Living with: þ en-US Father Mother þ en-US Otheren-USb. Name of child and county of legal residenceen-USRaceen-USSexen-USDate and place of birth Living with: þ en-US Father Mother þ en-US Otheren-USc. Name of child and county of legal residenceen-USRaceen-USSexen-USDate and place of birth Living with: þ en-US Father Mother þ en-US Otheren-USd. Name of child and county of legal residenceen-USRaceen-USSexen-USDate and place of birth Living with: þ en-US Father Mother þ en-US Otheren-USe. Name of child and county of legal residenceen-USRaceen-USSexen-USDate and place of birth Living with: þ en-US Father Mother þ en-US Otheren-USf. Name of child and county of legal residenceen-USRaceen-USSexen-USDate and place of birth Living with: þ en-US Father Mother þ en-US Otheren-USg. Name of child and county of legal residenceen-USRaceen-USSexen-USDate and place of birth Living with: þ en-US Father Mother þ en-US Otheren-USh. Name of child and county of legal residenceen-USRaceen-USSexen-USDate and place of birth Living with: þ en-US Father Mother þ en-US Other 2. þ The names and addresses and other relevant information of the parents, guardian, legal custodian, or nearest known þ relative are as follows: en-USIf the father/mother/guardian or legal custodian is a respondent, place a check mark in the column R. Name each father222s þ children and indicate for which child the father is a legal father by placing (LF) after the name of each child. If there is no (LF) designation, the father is þ presumed to be the putative father of the named child. For example: John Doe (LF), Mary Doe (LF). en-USa. Father222s nameen-USRen-USDOBen-USAddressen-USTelephone no.en-US Name(s) of child(ren)en-USb. Father222s nameen-USRen-USDOBen-USAddressen-USTelephone no.en-US Name(s) of child(ren)en-USc. Father222s nameen-USRen-USDOBen-USAddressen-USTelephone no.en-US Name(s) of child(ren)en-USd. Father222s nameen-USRen-USDOBen-USAddressen-USTelephone no.en-US Name(s) of child(ren)en-USe. Father222s nameen-USRen-USDOBen-USAddressen-USTelephone no.en-US Name(s) of child(ren)en-USf. Father222s nameen-USRen-USDOBen-USAddressen-USTelephone no.en-US Name(s) of child(ren)en-USg. Mother222s nameen-USRen-USDOBen-USAddressen-USTelephone no.en-USh. Mother222s nameen-USRen-USDOBen-USAddressen-USTelephone no.en-USi. Nonparent adult respondent222s nameen-USDOBen-USAddressen-USTelephone no.en-USj. Guardian/Legal custodian222s nameen-USRen-USDOBen-USAddressen-USTelephone no. þ en-USSee additional pages.en-USORIen-USMI- American LegalNet, Inc. www.FormsWorkFlow.com Petition (Child Protective Proceedings) þ (12/18) þ Page of Case No. Petition No. 3. þ þ a. þ There are no pending or resolved cases within the jurisdiction of the family division of the circuit court involving the þ family or family members of the person(s) who are the subject of the petition. þ þ b. þ There is one or more pending or resolved cases within the jurisdiction of the family division of the circuit court involving þ the family or family members of the person(s) who are the subject of the petition. Attached is a completed case þ inventory (form MC 21) listing those cases. þ þ c. þ It is unknown if there are pending or resolved cases within the jurisdiction of the family division of the circuit court þ involving the family or family members of the person(s) who are the subject of the complaint. 4. þ The named child(ren) come within the provisions of MCL 712A.2(b)(1)-(6) as follows ( en-UScheck all that apply): þ (See page 3 for specific allegations.) þ þ en-US en-US is a/are member(s) of or eligible for membership in the en-US þ en-US Indian tribe. þ en-US Removal is requested below and attached are details describing þ the active efforts made to provide remedial services and rehabilitative programs designed to prevent the breakup of the þ Indian family and documentation and attempts to identify the child222s tribe. þ þ A military/nonmilitary affidavit is attached. þ þ The parent or other person legally responsible for the care and maintenance of the child(ren), when able to do so, þ neglected or refused to provide proper or necessary support, education, medical, surgical, or other care necessary for the þ child(ren)222s health or morals, or he/she has subjected the child(ren) to a substantial risk of harm to his or her mental well- þ being, or he/she has abandoned the child(ren) without proper custody or guardianship. þ þ The home or environment, by reason of neglect, cruelty, drunkenness, criminality, or depravity on the part of the parent, þ guardian, nonparent adult, or other custodian, is an unfit place for the child(ren) to live. þ þ The parent has substantially failed, without good cause, to comply with a limited guardianship placement plan for the þ child(ren) pursuant to MCL 700.5205. þ þ The parent has substantially failed, without good cause, to comply with a court-structured plan for the child(ren) pursuant þ to MCL 700.5207 and 700.5209. þ þ The child(ren) has/have a guardian pursuant to the estates and protected individuals code and the parent meets both of þ the following criteria: (i) the parent, having the ability to support or assist in supporting the child(ren), has failed or neglected, þ without good cause, to provide regular and substantial support for two years or more before the filing of the petition or, if þ a support order has been entered, has failed to substantially comply with the order for two years or more before the filing þ of the petition, and (ii) the parent, having the ability to visit, contact, or communicate with the child(ren), has regularly and þ substantially failed or neglected, without good cause, to do so for two years or more before the filing of the petition. þ þ The juvenile is in danger of substantial physical or psychological harm and is dependent because þ þ the juvenile is homeless or not domiciled with a parent or other legally responsible person. þ þ the juvenile has repeatedly run away from home and is beyond the control of a parent or other legally responsible þ þ person. þ þ the juvenile is alleged to have committed a commercial sexual activity as that term is defined in MCL 750.462a or a þ delinquent act that is the result of force, fraud, coercion, or manipulation exercised by a parent or other adult. þ þ the juvenile222s custodial parent or legally responsible person has died or has become permanently incapacitated and no þ appropriate parent or legally responsible person is willing and able to provide care for the juvenile. þ 5. þ The reason(s) why it is contrary to the welfare of the child(ren) for the child(ren) to remain in the home are: en-US(Attach separate þ sheets as needed.) þ 6. þ The reasonable effort(s) made to prevent the removal of the child(ren) include: en-US(Attach separate sheets as needed.) American LegalNet, Inc. www.FormsWorkFlow.com Petition (Child Protective Proceedings) þ (12/18) þ Page of Case No. Petition No. 7. þ The specific allegations are: en-US(Attach separate sheets as needed.) 8. þ en-USI requesten-US the court to þ þ a. þ refer the matter to alternative services. þ þ b. þ authorize this petition and take jurisdiction over the child(ren). Further, I request the court to þ issue an order removing þ the child(ren) þ the abuser þ from the home. þ þ c. þ terminate parental rights of father to child(ren) 1.a. þ 1.b. þ 1.c. þ 1.d. þ 1.e. þ 1.f. þ 1.g. þ 1.h. þ þ þ d. þ terminate parental rights of mother to child(ren) 1.a. þ 1.b. þ 1.c. þ 1.d. þ 1.e. þ 1.f. þ 1.g. þ en-US 1.h.en-USI declare under the penalties of perjury that this petition has been examined by me and that its contents are true to the best of en-USmy information, knowledge, and belief.