Order Committing To Agency Or Family Independence Agency {PCA 322}

Approved, SCAO JIS CODE: OCA STATE OF MICHIGAN JUDICIAL CIRCUIT - FAMILY DIVISION COUNTY ORDER COMMITTING CHILD TO AGENCY/ DEPARTMENT OF HEALTH AND HUMAN SERVICES FILE NO. In the matter of Full name of child DOB: child is an Indian child 1. Date of hearing: THE COURT FINDS: 2. The parental rights/rights of person in loco parentis of Name Name Judge: Bar no. Relationship Relationship have been terminated. 3. It is reasonable not to make efforts to prevent removal of the child or to reunify the family. IT IS ORDERED: 4. The child named above is committed to Child-placing agency/Michigan Department of Health and Human Services under MCL 710.29(8) for the purpose of adoption. Date Judge Do not write below this line - For court use only PCA 322 (2/15) ORDER COMMITTING CHILD TO AGENCY/DEPARTMENT OF HEALTH AND MCL 710.29(8), MCL 712B.13, HUMAN SERVICES MCL 712B.23 American LegalNet, Inc. www.FormsWorkFlow.com