Fill and Sign the In the Matter of Use Childs Initials Only Form

IN THE SUPERIOR COURT FOR THE STATE OF ALASKA AT In the Matter of (use child’s initials only): ) ) CASE NO. ) A minor under 18 years of age. ) REQUEST FOR REVIEW HEARING ) ON TERMINATION ORDER Date of Birth: ) CINA Adoption Guardianship I am a person who voluntarily relinquished my par ental rights to the minor child named above. I ask the court to: enforce or change or vacate a privilege retained in the termination order because [AS 47.10.089(g)]: vacate the termination order and reinstate my parental rights relating to the minor because [AS 47.10.089(h)] (I understand that I can file this request only if an adoption or legal guardianship decree has not yet been entered.) : If you need a court appointed attorney, you must fill out form CP-410, Request for Appointed Lawyer. Date Signature I certify that on I Type or Print Name sent copies of this request to: Mailing Address City State & ZIP Clerk: Daytime Phone Number ORDER IT IS ORDERED that the request for review hearing is DENIED. Good cause for a review hearing has not been demonstrated. GRANTED. A review hearing will be held on at a.m./p.m., at . I certify that on I sent copies of this order to: Judge Date Clerk: Type or Print Name CN-360 (1/06)(cs) REQUEST FOR REVIEW HEARING ON TE RMINATION ORDER AS 47.10.089(g),(h)