In the matter of 
                                                                                                                                                       
1. Date of hearing: 

  DOB: 
 

Full name of child

  Judge: 

 

 , adoptee                            

 Bar no.

2. A petition has been filed to determine the identify of the father and to determine or terminate his parental rights to the child

named above, born out of wedlock on 

Date

 to 

Mother

 who has executed or proposes to execute a release or consent relinquishing her parental rights to the child.
 who has joined with her spouse in a petition for adoption.

3. Notice of this hearing has been given or waived as required by law.

4. The court has received evidence as to the identity and whereabouts of the father.

 5. The adoptee is an Indian child as defined in MCR 3.002(12) and the court has considered the application of the Indian
    Child Welfare Act and the Michigan Indian Family Preservation Act in this matter.

 

THE COURT FINDS that: (If identity of father is known, check 6. If father is not known, check 8.)

 6. The father of the child, born out of wedlock, is 
 
    (Check one)
 a. He submitted a verified affirmation of his paternity and a denial of his interest in custody of the child.
   
 b. He filed a disclaimer of paternity.
   
   
 c.  He was served with a notice of intent to release or consent at least 30 days before the expected date of confinement
            specified in that notice but failed to file an intent to claim paternity either before the expected date of confinement or
            before the birth of the child.
 failed to appear.
                     
 d. He was given proper notice of this hearing and 
 appeared and denied his interest in the custody of the child.
   
   
 e. He cannot be located after reasonable effort was made. He has not provided support for the mother, has not shown
            any interest in the child, and has not made provision for the child’s care for at least 90 days proceeding this hearing.
 f.   He appeared and requested custody of the child. The father has not established any custodial relationship with the
   
            child or did not provide any support or care for the mother during pregnancy or for either the mother or child after the 
            child’s birth. The court inquired into the fitness and the ability of the father to properly care for the child. It would not 
            be in the best intererst of the child to grant custody to the father.
   

 g. He is deceased.

 .

 7. The mother was married to 
 
    the conception to the date of birth of the child. He is not the father of the child.

 for part or all of the time from

 8. The identity of the father cannot be determined after reasonable effort was made. He has not made provision for the  
    child’s care and did not provide support for the mother during her pregnancy or during her confinement.

IT IS ORDERED that the parental rights of 
 

Date

 

Judge

 are terminated.

   

 
 

 
 
 
 
 
 
 
 
 
 
  
 
 
 
 

 

 

Do not write below this line - For court use onlyPCA 312 (6/17) ORDER TERMINATING RIGHTS OF FATHER WITHOUT RELEASE OR CONSENTMCL 710.36, MCL 712B.1 et seq., 25 USC 1901 et seq.Approved, SCAO                                 JIS CODE: OTFSTATE OF MICHIGANJUDICIAL CIRCUIT - FAMILY DIVISIONCOUNTY ORDER TERMINATING RIGHTS OF FATHERWITHOUT RELEASE OR CONSENTFILE NO.