The Legal Innovation & Technology Lab's Form Explorer ^Beta @ Suffolk Law School Last updated 2023-04-02

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Here is the text we could read:

In the matter of

First, middle, and last name of surrendered newborn child

1. I am the

mother

father

of the above named newborn child born on

Date of birth

Location of birth

2. The newborn was surrendered to

provider located at

Street address, city, and county of emergency services provider

The surrender was made by the

filing this petition.

mother

father

Date

The newborn is located in

I do not know where the child is presently located.

, less than 28 days from

County, Michigan.

Name of emergency services provider (indicate if unknown)

, an emergency services

4. Mother of newborn:

Name

Street address, city, state, zip and county

Father of newborn:

Name

Street address, city, state, zip and county

Date of birth:

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.
7. That blood or tissue typing be ordered if required by law.
8. Other:

Signature of petitioner

Name (type or print) Bar no.

Name (type or print)

Address

Date

I declare under the penalties of perjury that this petition has been examined by me and that its contents are true to the best
of my information, knowledge, and belief.

City, state, zip Telephone no.

STATE OF MICHIGANJUDICIAL CIRCUIT ‑ FAMILY DIVISIONCOUNTY PETITION OF PARENT FOR CUSTODYOF SURRENDERED NEWBORN CHILDCASE NO. AND JUDGEApproved, SCAOForm CCFD 03, Rev. 6/22MCL 712.10, MCL 712.11Page 1 of 1

CCFD 03, Petition of Parent for Custody of Surrendered Newborn Child

This info page is part of the LIT Lab's Form Explorer project. It is not associated with the Michigan state courts. To learn more about the project, check out our about page.

Downloads: You can download both the original form (last checked 2023-03) and the machine-processed form with normalized data fields.

About This Form:

Sourced from www.courts.michigan.gov/safe-delivery-newborn (2023-03)
Page(s): 1
Fields(s): 35
Average fields per page: 35
Reading Level: Grade 6
LIST Grouping(s): Unknown

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Identified Data Fields:

We have done our best to automaticly identify and name form fields according to our naming conventions. When possible, we've used names tied to our question library. See e.g., user1_name. If we think we've found a match to a question in our library, it is highlighted in green. Novel names are auto generated. So, you will probably need to edit some of them if you're trying to stick to the convention.

Here are the fields we could identify.

first_last_surrendered_child was First middle and last names of surrendered newborn child (0.58 conf)
mother__1 was mother (0.39 conf)
father__1 was father (0.36 conf)
users1_birthdate was Date of birth (1.00 conf)
location_birth was Location of birth (0.40 conf)
services_provider_unknown was Name of emergency services provider indicate if unknown (0.34 conf)
city_services_provider was Street address city and county of emergency services provider (0.33 conf)
mother__2 was mother_2 (0.33 conf)
father__2 was father_2 (0.34 conf)
signature_date__1 was Date (1.00 conf)
county_michigan was County Michigan (0.44 conf)
newborn_located was The newborn is located in (0.34 conf)
know_child_presently_located was I do not know where the child is presently located (0.31 conf)
users1_name was Name (1.00 conf)
date_birth__1 was Date of birth_2 (0.35 conf)
name was Name_2 (0.30 conf)
date_birth__2 was Date of birth_3 (0.35 conf)
signature_date__2 was Date_2 (1.00 conf)
name_type_print__1 was Name type or print (0.45 conf)
bar was Bar no (0.41 conf)
name_type_print__2 was Name type or print_2 (0.40 conf)
users1_address_line_one was Address (1.00 conf)
address was Address_2 (0.35 conf)
users1_address_line_two was City state zip (1.00 conf)
telephone__1 was Telephone no (0.44 conf)
city_state_zip was City state zip_2 (0.35 conf)
telephone__2 was Telephone no_2 (0.45 conf)
county was County (0.39 conf)
circuit was Circuit (0.33 conf)
cas_e was CASE NO (0.47 conf)
judge was Judge (0.39 conf)
text__1 was Text4 (0.35 conf)
text__2 was Text5 (0.35 conf)
text__3 was Text6 (0.35 conf)
text__4 was Text7 (0.35 conf)

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The Legal Innovation & Technology Lab's Form Explorer Beta @ Suffolk Law School Last updated 2023-04-02

CCFD 03, Petition of Parent for Custody of Surrendered Newborn Child

About This Form:

Identified Data Fields:

Create an Interactive Version of this Form:

The Legal Innovation & Technology Lab's Form Explorer ^Beta @ Suffolk Law School Last updated 2023-04-02