In the matter of 

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

TO:    

Name of child

1. 

  at 

Child’s place of birth

  The mother of the child is 

Mother’s full name

 was born on 

Date

 .

 .

2. A petition requesting the court to take jurisdiction of this child has been filed with this court.

3. The court has received information that you may be the natural father of the child.

4. You must appear at 

Location

 

to state your interest, if any, in the child.

 on 

Date and time

5. Your failure to appear at this hearing: a) is a denial of your interest in the child, b) is a waiver of notice for all subsequent
  hearings, c) is a waiver of a right to appointment of an attorney, and d) could result in termination of whatever rights you
  may have to the child.

If you require accommodations to use the court because of a disability or if you require a foreign language interpreter to help 
you to fully participate in court proceedings, please contact the court immediately to make arrangements.

 

                     

Clerk/Deputy clerk signature and date

If the court finds probable cause to believe that an identifiable person is the natural father of the minor, the court shall direct 
that notice be served on that person in any manner reasonably calculated to provide notice to the putative father, including 
publication if his whereabouts remain unknown after diligent inquiry.

STATE OF MICHIGANJUDICIAL CIRCUIT - FAMILY DIVISIONCOUNTYNOTICE TO PUTATIVE FATHERCASE NO.PETITION NO.JUDGECourt addressCourt telephone no.Approved, SCAOForm JC 53, Rev. 3/23MCR 3.921(D)Page 1 of 1Distribute to:  CourtPutative FatherCopies as neededJIS Code: NPF