In the matter of 
 
1. On 

                     

Date

Full name of child

2. You have the right to

 an order was entered terminating your parental rights to the child(ren) named above.

 DOB: 
 

 , adoptee

  a. Request a rehearing in the circuit court on the termination of your parental rights. If you choose to request a rehearing,
 

    you must do so by contacting this court in writing within 21 days of the date of the order terminating your parental rights.

  b. Appeal to the Court of Appeals the termination of your parental rights or the denial of your request to revoke release/
 
 
 

    consent of parental rights. If you wish to appeal this termination or denial, you must do so by filing a claim of appeal with
    the Court of Appeals of the State of Michigan within 21 days of the date of the order terminating your parental rights or
    the order denying revocation of release/consent.

  c.  If you released your parental rights for purposes of adoption or consented to the adoption of your child, you may withdraw 
 
 

    your release/consent at any time before entry of a final order of adoption by filing a written demand with the court
    requesting return of your child.

3. Your obligation to support the child continues until a court of competent jurisdiction modifies or terminates the obligation, an 
  order of adoption is entered, or the child is emancipated by operation of law.

4. In addition to the above rights you have the right to control the release of identifying information about yourself as follows:

  a. You may file with the Central Adoption Registry of the Michigan Department of Health and Human Services, at any time,
    a form called “Parent’s Consent/Denial to Release Information to Adult Adoptee.” With this form (copies available at all
 
    circuit courts or Michigan Department of Health and Human Services offices) you can consent to or deny the release of
 
    the following identifying information:
 

 
 

 
 

    •   Your name at the time of termination of your parental rights.
    •   Your most recent name and address, which is on file with the Central Adoption Registry.

    You can use this form anytime you change your mind about consenting to or denying the release of identifying  
    information.

 

  b. You may keep your name and address current with the Central Adoption Registry by sending this information to the
 

    Registry in writing.

NOTE: If you do not file a “Parent’s Consent/Denial to Release Information to Adult Adoptee,” or if you revoke a previously filed 
denial, then the identifying information stated in item 4 will be released upon the request of each child after reaching the age
of 18. If the other former parent has filed a denial of release of identifying information that has not been revoked, the identifying 
information about that parent will not be released. 

  

Do not write below this line - For court use onlyPCA 323-I (4/18) ADVICE OF RIGHTS AFTER ORDER TERMINATING PARENTAL RIGHTS TO INDIAN CHILD                          (Adoption Code)MCL 710.27, MCL 710.29, MCL 710.64, MCL 710.65, MCL 710.68, MCL 712B.13(3), (6), 25 USC 1913(c)Approved, SCAO JIS CODE: AVISTATE OF MICHIGANJUDICIAL CIRCUIT - FAMILY DIVISIONCOUNTYADVICE OF RIGHTS AFTERORDER TERMINATING PARENTAL RIGHTSTO INDIAN CHILD(Adoption Code)FILE NO.