IW-1639, 02/16 Order Concerning Termination of Parental Rights (Involuntary) - Indian Child Welfare Act 24724748.426, 48.427 and 48.43, Wisconsin Statutes; 25 U.S.C. 2471912 This form shall not be modified. It may be supplemented with additional material. Page 1 of 3 STATE OF WISCONSIN, CIRCUIT COURT, COUNTY IN THE INTEREST OF Name Date of Birth Order Concerning Termination of Parental Rights (Involuntary) Indian Child Welfare Act Case No. This Termination of Parental Rights hearing was held on [Date] , which is the effective date of this Order. THE COURT FINDS: 1. Notice was given to all those entitled to notice. 2. The child is subject to the Indian Child Welfare Act. 3. The parent(s) are A. Date of birth: B. Date of birth: C. Other possible father(s): Name: Date of birth: Name: Date of birth: Name: Date of birth: 4. There was no declaration of paternal interest. 5. Name(s) failed to appear at the hearing, and is/are in default. 6. This matter was tried to a jury. the court. A. The following grounds for termination of the parental rights of were found to exist: Mother Father abandonment relinquishment continuing need of protection or services continuing parental disability continuing denial of periods of physical placement or visitation child abuse failure to assume parental responsibility incestuous parenthood homicide or solicitation to commit homicide of parent parenthood as a result of sexual assault American LegalNet, Inc. www.FormsWorkFlow.com IW-1639, 02/16 Order Concerning Termination of Parental Rights (Involuntary) - Indian Child Welfare Act 24724748.426, 48.427 and 48.43, Wisconsin Statutes; 25 U.S.C. 2471912 This form shall not be modified. It may be supplemented with additional material. Page 2 of 3 commission of a felony against a child prior involuntary termination of parental rights to another child B. Continued custody of the child by the parent(s) or Indian custodian is is not likely to result in serious emotional or physical damage to the child, based on the testimony of one or more qualified expert witnesses. C. Active efforts were were not made to provide remedial services and rehabilitation programs designed to prevent the breakup of the Indian family. See attached Statement of Active Efforts (IW-1609) 7. The mother father is unfit. 8. It is in the best interest of the child that the parental rights of the mother father(s) be terminated after considering the following factors: The age and health of the child, both at the time of the disposition and, if applicable, at the time the child was removed from the home. Whether the child has substantial relationships with the parent or other family members, and whether it would be harmful to the child to sever these relationships. The wishes of the child. The duration of the separation of the parent from the child. Whether the child will be able to enter into a more stable and permanent family relationship as a result of placements and the results of prior placements. 9. Reasonable efforts to achieve the permanency goal of the permanency plan, including through an out-of-state placement if appropriate, were [Complete one of the following only if there is a permanency plan] made by the department or agency responsible for providing services as follows: not made by the department or agency responsible for providing services as follows: 10. Any parent who has appeared was informed of the provisions of 24724748.432, 48.433 and 48.434, Wis. Stats. 11. Other: 12. The evidence does not warrant the termination of the parental rights of [Name] . THE COURT ORDERS: 1. A. The parental rights of [Name of Parent(s)] is/are terminated. Guardianship, placement and care responsibility, and custody of the child remain with the parent whose rights have not been terminated. are transferred pending adoption to . Other: Placement has been made in accordance with the order of preference set forth in the Indian Child Welfare Act. OR There is good cause to depart from the order of placement preference in the Indian Child Welfare Act. If guardianship or custody is transferred to an agency, that agency shall be responsible for securing the adoption of the child or establishing the child in a permanent family setting. plan was filed. is attached. will be filed within 60 days. American LegalNet, Inc. www.FormsWorkFlow.com IW-1639, 02/16 Order Concerning Termination of Parental Rights (Involuntary) - Indian Child Welfare Act 24724748.426, 48.427 and 48.43, Wisconsin Statutes; 25 U.S.C. 2471912 This form shall not be modified. It may be supplemented with additional material. Page 3 of 3 The provisions of 24724748.432, 48.433 and 48.434, Wis. Stats. are attached. 1.B. The Petition to Terminate Parental Rights of [Name] is dismissed. 2. Other: THIS IS A FINAL ORDER FOR THE PURPOSE OF APPEAL. American LegalNet, Inc. www.FormsWorkFlow.com