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Petition Of Parent For Custody Of Surrendered Newborn Child CCFD 03 - Michigan
| Petition Of Parent For Custody Of Surrendered Newborn Child Form. This is a Michigan form and can be used in Safe Delivery Of Newborn Statewide . |
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Approved, SCAO STATE OF MICHIGAN CASE NO. JUDICIAL CIRCUIT - FAMILY DIVISION PETITION OF PARENT FOR CUSTODY COUNTY OF SURRENDERED NEWBORN CHILD In the matter of , a surrendered newborn child Full name of child 1. I am the mother father of the above named newborn child born on at Date of birth . Location of birth 2. The newborn was surrendered to , an emergency services provider Name of emergency services provider (indicate if unknown) located at . Street address, city, and county of emergency services provider The surrender was made by the mother father on , less than 28 days from filing this petition. Date 3. The newborn is located in County, Michigan. I do not know where the child is presently located. 4. Mother of newborn: Name Date of birth: Street address, city, state, zip and county Father of newborn: Date of birth: Name Street address, city, state, zip and county 5. I wish to revoke surrender of my child and release of parental rights, if any. I REQUEST: 6. That I be given custody of the child and that blood or tissue typing be ordered upon filing of this petition. 7. Other: 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 Signature of petitioner Name (type or print) Bar no. Name (type or print) Address Address City, state, zip Telephone no. City, state, zip Telephone no. Do not write below this line - For court use only CCFD 03 (1/01) PETITION OF PARENT FOR CUSTODY OF SURRENDERED NEWBORN CHILD MCL 712.10
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