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Petition To Determine Custody Of Child Temporarily Placed For Adoption PCA 335 - Michigan
| Petition To Determine Custody Of Child Temporarily Placed For Adoption Form. This is a Michigan form and can be used in Adoption Statewide . |
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Approved, SCAO STATE OF MICHIGAN PETITION TO FILE NO. JUDICIAL CIRCUIT - FAMILY DIVISION DETERMINE CUSTODY OF CHILD COUNTY TEMPORARILY PLACED FOR ADOPTION In the matter of DOB: Full name of child 1.On the child was temporarily placed in the home of the prospective adoptive parent(s). Date 2. Physical custody of the child was transferred to the prospective adoptive parents by: a. the parent/guardian with legal and physical custody or the child with the assistance of an adoption attorney. a child placing agency. b. the child placing agency having written authorization from the parent or guardian to make the temporary placement. 3. The persons interested in this proceeding are: (include father and mother if their parental rights have not been terminated) NAME RELATIONSHIP ADDRESS Father of Child Mother of Child Guardian of Child Prospective Parent(s) Adoption Attorney Child Placing Agency 4. The mother of the child is a minor. The name and address of the parent or guardian who agreed with the placement are Name . Street address City State Zip The father of the child is a minor. The name and address of the parent or guardian who agreed with the placement are Name Street address City State Zip . (PLEASE SEE OTHER SIDE) Do not write below this line - For court use only MCL 710.23d; MSA 27.3178(555.23d)PCA 335 (9/97) PETITION TO DETERMINE CUSTODY OF CHILD TEMPORARILY PLACED FOR ADOPTION <<<<<<<<<********>>>>>>>>>>>>> 2 5. An action within the jurisdiction of the family division of circuit court involving the family or family members of the minor has been previously filed in Court, Case Number , was assigned to Judge , and remains is no longer pending.6. a. I am the prosecuting attorney for this county. I have been notified that an adoption petition has not been filed and the child has not been returned to the parent or person having the right to legal custody. b. I am the prospective adoptive parent. I am unwilling or unable to proceed with the adoption. Physical custody of the child should should not be returned to the parent legal guardian agency for the following reasons: c. I am the representative of the child placing agency that temporarily placed the child. I state that: the agency is unable to proceed with adoption because of the unavailability of a parent or guardian to execute a release. the agency has legal rights to custody of the child and chooses not to proceed further with the adoption of the child by the prospective adoptive parents. the parent or guardian who authorized temporary placement desires to regain custody of the child. 7. I REQUEST the court to determine the custody of the child. 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 Name of petitioner (type or print) Agency name Address City, state, and zip Telephone no.
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