Approved, SCAO JIS CODE: TSN CASE NO. STATE OF MICHIGAN ORDER AFTER HEARING ON PETITION TO ACCEPT RELEASE AND TERMINATE RIGHTS COUNTY TO SURRENDERED NEWBORN CHILD JUDICIAL CIRCUIT - FAMILY DIVISION In the matter of , a surrendered newborn child Full name of child 1. Date of hearing: Judge: Bar no. 2. A petition requesting an order to accept the release of the surrendering parent and terminating the parental rights of both the surrendering and nonsurrendering parents has been filed by Name of agency a child-placing agency. , THE COURT FINDS by a preponderance of the evidence that: 3. The surrendering parent, Name the newborn. 4. , a. The nonsurrendering parent, has has not knowingly released , has been identified and located and provided Name with notice of the surrender of the newborn. b. The nonsurrendering parent has not been identified or located, and the child-placing agency has made reasonable efforts to provide notice of the surrender of the newborn. 5. The surrendering parent nonsurrendering parent has not filed a petition for custody of the newborn within the required 28 days following notice of the surrender of the newborn. IT IS ORDERED: 6. The release of the surrendering parent 7. The parental rights of the is is not surrendering parent accepted. nonsurrendering parent are terminated. Custody and care of the surrendered newborn child is granted to ,a child-placing agency. The prior court order dated the surrendered newborn child with the prospective adoptive parent(s) is continued. that authorizes placement of 8. The petition is denied. 9. Other: Date Judge Do not write below this line - For court use only CCFD 08 (9/07) ORDER AFTER HEARING ON PETITION TO ACCEPT RELEASE AND TERMINATE RIGHTS TO SURRENDERED NEWBORN CHILD MCL 712.17 American LegalNet, Inc. www.FormsWorkflow.com