Approved, SCAO

STATE OF MICHIGAN

JUDICIAL CIRCUIT - FAMILY DIVISION
COUNTY

In the matter of

Full name of child

ORDER TO
DETERMINE CUSTODY OF CHILD
TEMPORARILY PLACED FOR ADOPTION

FILE NO.

DOB:

JIS CODE:  ODC

1. Date of hearing:

Judge:

2. A petition to determine custody of the child has been filed.

3. Findings of fact and conclusions of law were made on the record.

THE COURT FINDS:

4. The child has been temporarily placed for adoption in the home of a prospective adoptive parent and the child

remains in this home.

has been removed from this home and is in the custody of the child-placing agency.

5. It appears necessary that an investigation should be made to determine if a petition for a child-protective proceeding should

be filed in the family division of the circuit court.

6. A petition for the appointment of a guardian has been filed.  Pending entry of an order of guardianship, a temporary order

of disposition for the welfare of the child should be made.

7. The child

should

should not

be returned to the custody of the

parent with authority for legal and physical custody of the child.

guardian with authority for legal and physical custody of the child.

child-placing agency with legal custody of the child.

IT IS ORDERED:

8. The prospective adoptive parent(s),

Name(s)

shall within 24 hours of receipt of this order return the child to

Name(s)

the parent who has the authority for legal and physical custody of the child.

the guardian who has the authority for legal and physical custody of the child.

(PLEASE SEE OTHER SIDE)

Do not write below this line - For court use only

Bar no.

,

,

PCA 336   (9/07)   ORDER TO DETERMINE CUSTODY OF CHILD TEMPORARILY PLACED FOR ADOPTION

MCL 710.23e

all proceedings in this matter until discharged by the court and shall immediately  * (See below.)

is appointed attorney to represent the child in

9.

a.

Name

OR

b. The matter is referred to the Michigan Department of Human Services to  * (See below.)

* investigate and, if necessary, file a petition on behalf of the child in the family division of the circuit court under MCL

712A.2(b).  If a petition is not filed in the family division within 14 days of this order, the child shall be returned to the parent

or the guardian with authority for legal and physical custody.

Pending a preliminary hearing in a child-protective proceeding or the return of the child to the parent or guardian, the child

shall be moved from the home of the prospective adoptive parent and placed in licensed foster care under the supervision

10. Pending hearing on the petition for the appointment of a guardian for the child, the court makes the following disposition

of the Michigan Department of Human Services.

for the welfare of the child:

Date

Judge