STATE OF MICHIGAN

JUDICIAL CIRCUIT - FAMILY DIVISION
COUNTY

ORDER FOLLOWING HEARING TO
TERMINATE PARENTAL RIGHTS 

ORDER 

 

 OF 
 

CASE NO.

PETITION NO.

JUDGE

Court address

Court telephone no.

In the matter of 

First and last name(s), alias(es)

1. Date of hearing: 

2. Removal date: 

 

 

  

  Judge/Referee: 

  

 (Specify for each child if different.)

3. An adjudication was held and the child(ren) was/were found to come within the jurisdiction of the court.

4. A petition to terminate parental rights has been filed and notice of hearing on the petition was given as required by law.

5. Specific findings of fact and law regarding this proceeding have been made on the record or by separate written opinion 
  of the court.

THE COURT FINDS:
6. 
 
 
 
 
 

 a. Reasonable efforts were made to preserve and unify the family to make it possible for the child(ren) to safely return 

        to the child(ren)’s home. Those efforts were unsuccessful.

 b. Reasonable efforts were not made to preserve and unify the family because it was previously determined in a prior

        court order to be detrimental to the child(ren)’s health and safety.

 c.  Reasonable efforts were not required to preserve and reunify the family as determined in a prior court order. (*This 

        requires a permanency planning hearing within 28 days.)

7. There is clear and convincing evidence that a statutory basis exists for terminating the parental rights of
 

 , parent(s) of the child(ren).

Name(s) of parent(s)

 8. The child(ren) is/are Indian as defined in MCR 3.002(12).
 a. Active efforts have not been made.
   
   
 b. Active efforts have been made to provide remedial services and rehabilitative programs designed to prevent the 
            breakup of the Indian family. These efforts have proved unsuccessful and there is evidence beyond a reasonable
            doubt, including qualified expert witness testimony, that continued custody of the child(ren) by the parent(s) or 
            Indian custodian will likely result in serious emotional or physical damage to the child(ren).
   
            breakup of the Indian family. These efforts have proved successful and there is not evidence beyond a 
            reasonable doubt, including qualified expert witness testimony, that continued custody of the child(ren) by the 
            parent(s) or Indian custodian will likely result in serious emotional or physical damage to the child(ren).

 c.  Active efforts have been made to provide remedial services and rehabilitative programs designed to prevent the

 
 
 
 
 
 
 
 
 

9. Termination of parental rights 

 

 is 

 is not 

 

in the best interests of the child(ren).

*NOTE: If proper notice has already been given, the permanency planning hearing can be conducted immediately following the termination 
hearing. This is especially useful in obtaining a uniform date for future permanency planning hearings when parental rights have been 
terminated to more than one child and the removal dates of the children are different. Use form JC 76.

USE NOTE: Do not use this form when terminating parental rights after release under the adoption code. Use forms PCA 318 and 
PCA 322. If one parent has signed a release under the adoption code, do not include his or her name in the order.

Approved, SCAO
Form JC 63, Rev. 12/22
MCL 400.201 et seq., MCL 712A.18, MCL 712A.19a, 
MCL 712A.19b, MCL 712A.20, 25 USC 1912, MCR 3.976(B)(1), MCR 3.977
Page 1 of 2

JIS Code: TRPOrder Following Hearing to Terminate Parental Rights 
Page 2 of 2

(12/22) 

Case No. 
 

IT IS ORDERED:

 10.  The parental rights of 

Name(s) of parent(s)

 

 

 
 

 

 

      are terminated, and additional efforts for reunification of the child(ren) with the parent(s) shall not be made.

 a. The child(ren) is/are continued in the temporary custody of this court and remain in placement with the 

 11. 
              department for care and supervision.

 b. The child(ren) is/are committed to the department for permanency planning, supervision, care, and placement 

     
              under MCL 400.203.

 12.  While the child(ren) is/are placed out of the home, the friend of the court must take the necessary steps to appropriately 
      assign or redirect child support pursuant to law.

 13.  The Director of the department is appointed special guardian to receive any benefits now due or to become due the
      child(ren) from the government of the United States.

 14.  Other: (Include reimbursement provisions as required by MCL 712A.18[2]. Attach separate sheet.)

15.  The court reserves the right to enforce payments of reimbursement that have accrued up to and including the date of 
 

  this order.

 16.  The supplemental petition to terminate the parental rights of 

 Name(s) of parent(s)

17.  A 

 

 review hearing 

 

 permanency planning hearing 

  will be held 

Date

 is denied.

 .

Recommended by:

 Referee signature and date

Judge signature and date

Reference Note: the term “department” refers to the Michigan Department of Health and Human Services.