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Order Concerning Termination Of Parental Rights (Involuntary) Form. This is a Wisconsin form and can be use in Circuit Court Statewide.
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Tags: Order Concerning Termination Of Parental Rights (Involuntary), JC-1639, Wisconsin Statewide, Circuit Court
For Official Use
STATE OF WISCONSIN, CIRCUIT COURT,
COUNTY
IN THE INTEREST OF
Order Concerning
Termination
of Parental Rights
(Involuntary)
Name
Case No.
Date of Birth
This termination of parental rights hearing was held on [Date]
of this order.
, which is the effective date
THE COURT FINDS:
1. Notice was given to all those entitled to notice.
2. The provisions of the Indian Child Welfare Act do not apply.
(For an Indian child, use the Indian Child Welfare Act version [IW-1639] of this order.)
3. The parent(s) are
a. Mother’s name:
b. Father’s name:
c. Other possible father(s):
Name:
Name:
Name:
Date of birth:
Date of birth:
Date of birth:
Date of birth:
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.
The following grounds for termination of the parental rights of
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
commission of a felony against a child
prior involuntary termination of parental rights to another child
7. The
mother
father
were found to exist:
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 likelihood of the child’s adoption after termination.
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.
JC-1639, 03/12 Order Concerning Termination of Parental Rights (Involuntary)
§§48.427 and 48.43, Wisconsin Statutes
This form shall not be modified. It may be supplemented with additional material.
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Order Concerning Termination of Parental Rights (Involuntary)
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Case No.
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
the termination, taking into account the conditions of the child’s current placement, the likelihood of
future placements and the results of prior placements.
9. The child is placed in sustaining care because
the child is not likely to be adopted.
adoption is not in the best interest of the child.
10. Reasonable efforts to achieve the goal(s) 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.
not made by the department or agency responsible for providing services.
11. Any parent who has appeared was informed of the provisions of §§48.432, 48.433 and 48.434, Wis. Stats.
12. Other:
13. 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)]
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:
is/are terminated.
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. The child’s permanency plan
was filed.
is attached.
will be filed within 60 days.
The provisions of §§48.432, 48.433 and 48.434, Wis. Stats., are attached.
b. The petition to terminate parental rights of [Name]
is dismissed.
2. Other:
THIS IS A FINAL ORDER FOR PURPOSES OF APPEAL.
BY THE COURT:
Circuit Court Judge
Name Printed or Typed
Date
JC-1639, 03/12 Order Concerning Termination of Parental Rights (Involuntary)
§§48.427 and 48.43, Wisconsin Statutes
This form shall not be modified. It may be supplemented with additional material.
Page 2 of 2
American LegalNet, Inc.
www.FormsWorkFlow.com
