Approved, SCAO

STATE OF MICHIGAN

JUDICIAL CIRCUIT - FAMILY DIVISION
COUNTY

In the matter of

Full name of child

child

1. Date of hearing:

THE COURT FINDS:

ORDER PLACING CHILD AFTER CONSENT

JIS CODE:  OTR

FILE NO.

DOB:

   , adoptee
adoptee is an Indian

Judge:

Bar no.

2. A petition for an order of adoption has been filed.

The petitioner is married but the spouse did not join in the petition.

3. A report of investigation has been filed and reviewed by the court.

Good cause has been shown that the spouse of the petitioner is excused from joining in or consenting to the petition.

4. The best interests of the adoptee will be served by the adoption.

5. The rights of the parent(s) or the person in loco parentis have been terminated.

6. Other:

IT IS ORDERED:

Name(s)

8.

provided to the adoptee.

10. Other:

7. The adoptee is made a ward of this court for purposes of adoption and placement in the home of the adoptive parent(s),

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

shall make reports to the court regarding the adjustment of the adoptee in the home every
the order of adoption is entered.

          months, until

9. The adoptive parent(s) may consent to all medical, surgical, dental, optical, psychological, educational, and related services

, is approved.

  shall supervise the adoptee in the home and

Date

Judge

NOTE:  "Absent good cause to the contrary, the . . . preadoptive placement of an Indian child must be in the following order of
preference: (1) a member of the child's extended family; (2) a member of the Indian child's tribe; or (3) an Indian family."
MCL 712B.23(1).

Do not write below this line - For court use only

PCA 320   (2/15)   ORDER PLACING CHILD AFTER CONSENT

MCL 710.51, MCL 710.52, MCL 712B.23