Approved, SCAO

STATE OF MICHIGAN

JUDICIAL CIRCUIT - FAMILY DIVISION
COUNTY

In the matter of

Full name of child

1. I am the adult adoptee and on

Date

and contact a former family member of mine.

PETITION AND ORDER REGARDING RELEASE
OF INFORMATION FROM CONFIDENTIAL
INTERMEDIARY AND COURT

JIS CODE: PCS and MiCOURT - RIC
 TCS - CONF

FILE NO.

PETITION

the court appointed a confidential intermediary to search for

   , adoptee

2. More than six months have passed since the appointment and the confidential intermediary has failed to contact the former

family member.

3. I REQUEST that the court issue an order to release the confidential information described in MCL 710.27(3) and any additional

information obtained by the confidential intermediary.

Date

Signature of petitioner

Name of petitioner (type or print)

4. Date of hearing:

6.

Name

Address

City, state, zip

ORDER

Judge:

Telephone no.

Bar no.

5. The confidential intermediary shall search for another six months.

is appointed successor confidential intermediary to search

7. The identifying information in MCL 710.27(3) and any additional information obtained by the confidential intermediary shall be

for and contact the former family member.

released to the adult adoptee.

8. The petition is denied.

Date

Judge

Do not write below this line - For court use only

PCA 344   (2/15)   PETITION AND ORDER REGARDING RELEASE OF INFORMATION FROM CONFIDENTIAL INTERMEDIARY

AND COURT

MCL 710.68b(6)



Petition and Order Regarding Release of Information from Confidential Intermediary and Court

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About This Form:

• Sourced from www.courts.michigan.gov/adoptions-court-forms (2023-03)
• Page(s): 1
• Fields(s): 10
• Average fields per page: 10
• Reading Level: Grade 11
• LIST Grouping(s): CO-00-00-00-00.

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