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Approved, SCAO

STATE OF MICHIGAN

JUDICIAL CIRCUIT - FAMILY DIVISION
COUNTY

PETITION FOR ADOPTION

Related Within 5th Degree
Other (Excluding Direct Adoption)

FILE NO.

JIS CODE: APF

Name

Address, City, State, Zip

Relationship
to Adoptee

Date and Place
of Birth

, adoptee

1. An action within the jurisdiction of the family division of circuit court involving the family or family members of the minor

Court, Case Number

, was

, and

remains

is no longer

pending.

Birth date and time

First Middle Last

Address

City, state, zip

Father’s name (type or print) Birth date

Mother’s name and maiden name (type or print) Birth date

b. The rights of the parents have been terminated by a court of competent jurisdiction and parental rights are vested in

In the matter of

Full name of child

The petitioners are:

Adopting parent

Maiden:

Adopting parent

Maiden:
Each adopting petitioner states:

has been previously filed in

assigned to Judge

2. I desire to adopt:

Full name of child (type or print)

City, county, and state of birth

Current residential address (if known)

3. The adoptee will be my heir at law.

4. The adoptee’s name will

not be changed.
be changed to

5. The adoptee’s property is

a. The adoptee’s parents are

Address

City, state, zip

Name and address of court or agency

Do not write below this line - For court use only(See additional pages)PCA 301 (6/18) PETITION FOR ADOPTIONMCL 710.24, MCL 710.26, MCL 710.45, MCL 710.46, MCL 710.52, MCL 710.56, MCL 712B.9(1)Note: For stepparent adoptions, use form PCA 301b.

Petition for Adoption

(6/18) Page

File No.

7. The adoptee’s court-appointed guardian and/or conservator is/are (attach copy[ies] of letters of authority)

Name(s) and address(es)

8. The adoptee has been living with the petitioners in their home for

months before filing this petition.

9. I have been unable to obtain the required consent to adopt the child from the court, Michigan Department of Health and
Human Services or child-placing agency having permanent custody, or from the persons to whom the child was released.
A motion alleging that the decision to withhold consent was arbitrary and capricious is attached.

10. I am married but my spouse is not joining me in this petition because: (Attach separate sheet as needed.)

11. The adoptee is an Indian child as defined in MCR 3.002(12). The identity of the tribe is

Name of tribe, if known

I REQUEST:

12. Termination of all existing parental rights inconsistent with the order of adoption, entry of an order approving placement of

the child with me, and entry of an order of adoption with the adoptee’s name recorded as stated in item 4.

13. The adoption be completed immediately because

14. The court to waive the required investigation because the adoptee has been placed in foster care with me for at least 12
months and a foster family study was completed or updated within the last 12 months.

I declare that the statements above are true to the best of my information, knowledge, and belief.

Attorney signature

Date

Attorney name (type or print) Bar no.

Signature of petitioner

Address

Signature of petitioner

City, state, zip Telephone no.

Petitioner telephone no.

Address

City, state, zip

Agency Contact Information:

Name of agency representative (type or print)

Agency name

Telephone no.

E-mail

Petition for Adoption

(6/18) Page

File No.

Court agent or employee, child-placing agency, or Michigan Department of Health and Human Services

is directed to fully investigate and

report its findings in writing to this court, within 3 months of this order, in accordance with the provisions of MCL 710.46.

16. The full investigation is waived. The petitioner(s) shall file a copy of the most recent foster family study as updated and

supplemented.

17. The petitioner(s) shall give notice of this petition to the persons prescribed in MCR 3.800(B) in accordance with MCR

3.802(A)(3) and MCR 3.807(B), if applicable (use form PCA 352).

IT IS ORDERED:

15.

Date

Judge Bar no.

PCA 301, Petition for Adoption

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/adoptions-court-forms (2023-03)
Page(s): 3
Fields(s): 78
Average fields per page: 26
Reading Level: Grade 8
LIST Grouping(s): FA-00-00-00-00.

Use our Rate My PDF tool to learn more. Go beyond the above insights and learn more about this or any pdf form at RateMyPDF.com, includes: counts of difficult words used, passive voice decetion, and suggestions for how to make the form more usable.

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.

stat_e_n_l_county was STATE OF MICHIGAN JUDICIAL CIRCUIT FAMILY DIVISION COUNTY (0.64 conf)
related_within_th_degree was Related Within 5th Degree (0.37 conf)
excluding_direct_adoption was Other Excluding Direct Adoption (0.37 conf)
full_name_child was Full name of child (0.35 conf)
adopting_parent__1 was Adopting parent (0.49 conf)
relationship_adopting_parent__1 was Relationship to AdopteeAdopting parent Maiden (0.42 conf)
address_city_state_adopting__1 was Address City State ZipAdopting parent Maiden (0.44 conf)
date_place_adopting_parent__1 was Date and Place of BirthAdopting parent Maiden (0.33 conf)
adopting_parent__2 was Adopting parent_2 (0.40 conf)
relationship_adopting_parent__2 was Relationship to AdopteeAdopting parent Maiden_2 (0.42 conf)
address_city_state_adopting__2 was Address City State ZipAdopting parent Maiden_2 (0.38 conf)
date_place_adopting_parent__2 was Date and Place of BirthAdopting parent Maiden_2 (0.38 conf)
action_division_involving was 1 An action within the jurisdiction of the family division of circuit court involving the family or family members of the minor (0.37 conf)
court_case_number was Court Case Number (0.46 conf)
was was was (0.41 conf)
and was and (0.41 conf)
remains was remains (0.32 conf)
longer was is no longer (0.37 conf)
full_name_child_type_print was Full name of child type or print (0.44 conf)
birth_date_time was Birth date and time (0.43 conf)
city_county_state_birth was City county and state of birth (0.47 conf)
current_residential_address was Current residential address if known (0.51 conf)
changed__1 was not be changed (0.41 conf)
changed__2 was be changed to (0.44 conf)
first was First (0.34 conf)
middle was Middle (0.31 conf)
last was Last (0.34 conf)
undefined__1 was undefined (0.38 conf)
adoptees_parents was a The adoptees parents are (0.35 conf)
fathers_name_type_print was Fathers name type or print (0.49 conf)
birth_date__1 was Birth date (0.43 conf)
mothers_name_maiden_type_print was Mothers name and maiden name type or print (0.41 conf)
birth_date__2 was Birth date_2 (0.44 conf)
users1_address_line_one was Address (1.00 conf)
address__1 was Address_2 (0.35 conf)
users1_address_line_two was City state zip (1.00 conf)
city_state_zip__1 was City state zip_2 (0.35 conf)
rights_court_jurisdiction was b The rights of the parents have been terminated by a court of competent jurisdiction and parental rights are vested in (0.38 conf)
name_address_court_agency was Name and address of court or agency (0.41 conf)
text__1 was Text1 (0.35 conf)
text__2 was Text2 (0.35 conf)
text__3 was Text3 (0.35 conf)
text__4 was Text4 (0.35 conf)
text__5 was Text5 (0.35 conf)
of was of (0.38 conf)
adoptees_attach_authority was 7 The adoptees courtappointed guardian andor conservator isare attach copyies of letters of authority (0.48 conf)
living_petitioners_home was 8 The adoptee has been living with the petitioners in their home for (0.34 conf)
obtain_required_consent was 9 I have been unable to obtain the required consent to adopt the child from the court Michigan Department of Health and (0.40 conf)
spouse_joining_needed was 10 I am married but my spouse is not joining me in this petition because Attach separate sheet as needed (0.43 conf)
adoptee_indian_child_defined_mc_r_identity_tribe was 11 The adoptee is an Indian child as defined in MCR 300212 The identity of the tribe is (0.36 conf)
names_addresses was Names and addresses (0.47 conf)
months_filing_petition was months before filing this petition (0.51 conf)
name_tribe_known was Name of tribe if known (0.35 conf)
child_order_stated_item was the child with me and entry of an order of adoption with the adoptees name recorded as stated in item 4 (0.36 conf)
adoption_completed_immediately was 13 The adoption be completed immediately because (0.41 conf)
waive_required_least was 14 The court to waive the required investigation because the adoptee has been placed in foster care with me for at least 12 (0.38 conf)
undefined__2 was undefined_3 (0.39 conf)
signature_date__1 was Date (1.00 conf)
attorney_name_type_print was Attorney name type or print (0.50 conf)
bar__1 was Bar no (0.41 conf)
address__2 was Address_3 (0.35 conf)
city_state_zip__2 was City state zip_3 (0.35 conf)
telephone__1 was Telephone no (0.44 conf)
petitioner_telephone was Petitioner telephone no (0.45 conf)
agency_representative_type was Name of agency representative type or print (0.46 conf)
address__3 was Address_4 (0.35 conf)
agency_name was Agency name (0.47 conf)
city_state_zip__3 was City state zip_4 (0.35 conf)
telephone__2 was Telephone no_2 (0.45 conf)
email was Email (0.38 conf)
text__6 was Text6 (0.35 conf)
text__7 was Text7 (0.35 conf)
page was Page (0.27 conf)
employee_agency_services was Court agent or employee childplacing agency or Michigan Department of Health and Human Services (0.43 conf)
unknown was 15 (0.38 conf)
investigation_petitioners_recent_updated was 16 The full investigation is waived The petitioners shall file a copy of the most recent foster family study as updated and (0.36 conf)
shall_give_notice_accordance was 17 The petitioners shall give notice of this petition to the persons prescribed in MCR 3800B in accordance with MCR (0.42 conf)
signature_date__2 was Date_2 (1.00 conf)
bar__2 was Bar no_2 (0.37 conf)

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

PCA 301, Petition for Adoption

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