FORM SUMMARY Name of Form: Petition for Termination of Parental Rights Form Number: JC-1630 Statutory Reference: §§48.41, 48.415, 48.42, Wisconsin Statutes Benchbook Reference: JV 13 Purpose of Form: To initiate a proceeding to terminate the parental rights of a parent. Who Completes It: Party who is seeking the termination. Distribution of Form: Original to court file, copies of the Summons and Petition are to be served on: • parent or parents of child (unless parent has waived right to notice); • unadjudicated father who has filed a declaration of interest; • person who has lived in a familial relationship with child and may be the father; • guardian, guardian ad litem, and legal custodian of child; • child (if 12 years of age or older); • any other person to whom notice is required under ch. 822, Wisconsin Statutes, excluding foster parents or treatment foster parent. Accompanying Forms: If the space provided for reciting the facts and circumstances supporting the termination is insufficient, additional materials may be attached. New Form/Modification: Modification, last update 08/06. Modifications: Added Indian Child Welfare Act (ICWA) language and references. New ICWA version created – IW-1630. Comments: None. About this form: This form is the product of the Wisconsin Records Management Committee, a committee of the Director of State Court's Office and a mandate of the Wisconsin Judicial Conference. If you have additional information that does not change the meaning of the form, attach it on a separate page. The form itself shall not be altered. Date: 04/24/2008 Page 1 American LegalNet, Inc. www.FormsWorkflow.com For Official Use COUNTY STATE OF WISCONSIN, CIRCUIT COURT, Petition for Termination of Parental Rights IN THE INTEREST OF a person under the age of 18. Case No. Date of Birth UNDER OATH, I STATE that the child’s name and birth date are as stated above and: 1. Petitioner’s Name and Address County where child is present at time of filing petition Child’s Address Mother’s Name Mother’s Address Birthdate Father’s Name Father’s Address Birthdate Child’s Legal Guardian Legal Guardian’s Address Child’s Legal Custodian Sex Legal Custodian’s Address 2. The petitioner is interested as 3. The child is a marital non-marital child. biological (nonadjudicated). alleged. presumed. adjudicated. 4. The father is Names and addresses of additional possible fathers, if known, are attached. 5. The petitioner seeks termination of parental rights of the: will not may will mother, who under §48.41, Wis. Stats. consent to the termination of her parental rights If involuntary, grounds for termination of parental rights exist under §48.415( A statement of the facts and circumstances which support these grounds is as follows: JC-1630, 04/08 Petition for Termination of Parental Rights unknown. ), Wis. Stats. See attached §§48.41, 48.415, and 48.42, Wisconsin Statutes. This form shall not be modified. It may be supplemented with additional material. Page 1 of 2 American LegalNet, Inc. www.FormsWorkflow.com Petition for Termination of Parental Rights Page 2 of 2 Case No. will not consent to the termination of his parental rights may will father, who under §48.41, Wis. Stats. ), Wis. Stats. If involuntary, grounds for termination of parental rights exist under §48.415( See attached A statement of the facts and circumstances which support these grounds is as follows: additional possible fathers (known or unknown). Attach name(s) if known. The statutory grounds for termination of the parental rights of each possible father and the facts and circumstances which support these grounds are attached. 6. a. The child is not subject to the federal Indian Child Welfare Act OR b. It is unknown at this time whether the child is subject to the federal Indian Child Welfare Act. (For an Indian Child, use the Indian Child Welfare Act version (IW-1630) of this petition.) 7. The Uniform Child Custody Jurisdiction Act Affidavit is attached to this petition. 8. The best interests of the child will be served by termination of the parental rights of the parent(s). 9. The best interests of the minor birth parent(s) will be served by the termination of parental rights. his her their Subscribed and sworn to before me on Signature of Petitioner Notary Public, State of Wisconsin Name Printed or Typed My commission expires: Signature of Petitioner Name Printed or Typed Name of Attorney Address Telephone Number Bar Number JC-1630, 04/08 Petition for Termination of Parental Rights §§48.41, 48.415, and 48.42, 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