Michigan > Statewide > Adoption
Petition And Order To Appoint Confidential Intermediary PCA 342 - Michigan
| Petition And Order To Appoint Confidential Intermediary Form. This is a Michigan form and can be used in Adoption Statewide . |
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Approved, SCAO STATE OF MICHIGAN FILE NO. JUDICIAL CIRCUIT - FAMILY DIVISION PETITION AND ORDER TO APPOINT COUNTY CONFIDENTIAL INTERMEDIARY In the matter of , adoptee Full name of child PETITION 1. I am an adult adoptee. adoptive parent of the adoptee who is a minor. adult child of the deceased adoptee whose date of death is . Date I REQUEST the court to appoint a confidential intermediary to search for and contact a former family member of mine who is believed to be my mother. father. grandparent. adult sibling. 2. I am a former family member of the adoptee. I am the adoptees parent. grandparent. adult sibling. I REQUEST the court to appoint a confidential intermediary to search for and contact the adult adoptee. an adult child of the deceased adoptee whose date of death is Date .I declare that this petition has been examined by me and that its contents are true to the best of my information, knowledge, and belief. Date Signature of petitioner Address Name of petitioner (type or print) City, state, zip Telephone no. ORDER 3. Date of hearing: Judge: Bar no. 4. is appointed confidential intermediary to search for and Name (type or print) contact the former mother. the former father. the former grandparent. the adult adoptee. an adult child of the deceased adoptee. adult sibling. The confidential intermediary shall file with the court within 6 months of this order a written report of the intermediarys efforts to search for and contact the individual and any results. The confidential intermediary shall have access to the adoptees court file and records. 5. The former mother former father has on file with the central adoption registry a denial of consent to the release of identifying information. The petition to search for that former parent is denied. Date Judge Do not write below this line - For court use only PCA 342 (9/97) PETITION AND ORDER TO APPOINT CONFIDENTIAL INTERMEDIARY MCL 710.68b; MSA 27.3178(555.68b)
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