Approved, SCAO
JIS CODE: RIC
STATE OF MICHIGAN
JUDICIAL CIRCUIT - FAMILY DIVISION
COUNTY
PETITION AND ORDER FOR RELEASE OF INFORMATION FROM CONFIDENTIAL INTERMEDIARY AND COURT
FILE NO.
In the matter of
Full name of child
, adoptee PETITION
1. I am the adult adoptee and on
Date
the court appointed a confidential intermediary to search for
and contact a former family member of mine. 2. More than 6 months have passed since the appointment and the confidential intermediary has failed to contact the former family member. 3. I REQUEST an order to release the confidential information described in MCL 710.27(3) and any additional information obtained by the confidential intermediary. I declare that this petition has been examined by me and that its contents are true to the best of my information, knowledge, and belief.
Date Signature of petitioner Name of petitioner (type or print) Address City, state, zip Telephone no.
ORDER 4. Date of hearing: Judge:
Bar no.
5. The confidential intermediary shall search for another 6 months. 6.
Name
is appointed successor confidential intermediary to search
for and contact the former family member. 7. The intermediary shall file with the court within 6 months of this order a written report of efforts made to search for and to contact the individual and the results. 8. The successor confidential intermediary shall have access to the adoptee's court file and records and the court may furnish copies of its records to the successor confidential intermediary upon receipt of the costs of reproduction. 9. The court shall release to the adult adoptee the identifying information contained in MCL 710.27(3) and any additional information obtained by the confidential intermediary.
Date Judge
Do not write below this line - For court use only
PCA 344 (9/07)
PETITION AND ORDER FOR RELEASE OF INFORMATION FROM CONFIDENTIAL INTERMEDIARY AND MCL 710.68b(6) COURT