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