Approved, SCAO JIS CODE: OTT STATE OF MICHIGAN JUDICIAL CIRCUIT - FAMILY DIVISION COUNTY ORDER FOR BLOOD OR TISSUE TYPING OR DNA PROFILE (SAFE DELIVERY OF NEWBORN ACT) In the matter of FILE NO. , a surrendered newborn child Full name of child 1. Date of hearing: Judge: 2. Alleged parent(s), Bar no. , Name(s) of petitioner(s) filed a petition for custody of the surrendered newborn child. Testing to determine whether the individual(s) is/are the biological parent(s) is required before the hearing on the petition. THE COURT FINDS: 3. The newborn child was surrendered to an emergency service provider and a petition for custody of the child was filed within 28 days after the surrender. 4. The petitioner claims to be the biological mother father of the surrendered newborn child. 5. The petitioner is indigent and unable to pay for the cost of testing. IT IS ORDERED: 6. The petitioner(s), , Name(s) of petitioner(s) and the surrendered newborn child shall have a blood or tissue typing or DNA profile conducted to determine whether he/she is likely to be or is not the biological parent of the child. 7. The petitioner(s) and the child shall appear at the location designated and on the date and time set as notified by the child-placing agency, . Name(s) of agency(ies) 8. Payment for the tests must be made as follows: Payment for the tests was waived because of indigency. 9. In accordance with MCL 722.716, the blood or tissue typing or DNA-identification profiling shall be conducted by a person accredited for paternity or maternity determination by a nationally recognized scientific organization, including, but not limited to, the American Association of Blood Banks, and a report of the results shall be submitted to the child-placing agency. 10. The result of blood or tissue typing or DNA-identification profiling and the summary report shall be filed with the court and served by the child-placing agency on the individuals. 11. At the time of serving the results and summary upon the alleged parent(s), the child-placing agency shall also serve written notice that objection to the DNA-identification profiling or the summary report is waived unless specific objections are made in writing within 14 calendar days after service of the notice and delivered to the court at the address specified in the notice. 12. Refusal or failure to submit to the typing or DNA-identification profiling may result in a dismissal of the custody action in addition to other remedies available to the court. Date Judge Do not write below this line - For court use only MCL 712.11, MCL 712.12, MCL 722.716 CCFD 04 (9/07) ORDER FOR BLOOD OR TISSUE TYPING OR DNA PROFILE (SAFE DELIVERY OF NEWBORN ACT) American LegalNet, Inc. www.FormsWorkflow.com