Fill and Sign the Order Parental Rights Form

STATE OF WISCONSIN, CIRCUIT COURT,       COUNTY For Official Use IN THE INTEREST OF       Name Order Concerning Termination of Parental Rights (Involuntary)       Date of Birth Case No.       THE COURT FINDS: 1. Notice has been given to all those entitled to notice. 2. The provisions of the Indian Child Welfare Act do not apply. have been followed. 3. The parent(s) are: a. Mother’s name:       Date of birth:       b. Father’s name:       Date of birth:       c. Other possible father(s): Name:       Date of birth:       Name:       Date of birth:       Name:       Date of birth:       4. There has been no declaration of paternal interest. 5. (Name(s):       failed to appear at the hearing, and is/are in default. 6. This matter was tried to a jury the court and the following grounds for termination of the parental rights of       were found to exist: Mother Father abandonment relinquishment continuing need of protection or services continuing parental disability continuing denial of periods of physical placement or visitation child abuse failure to assume parental responsibility incestuous parenthood homicide or solicitation to commit homicide of parent parenthood as a result of sexual assault commission of a serious felony against one of the person's children prior involuntary termination of parental rights to another child 7. The mother father is unfit. 8. It is in the best interest of the child that the parental rights of the mother father(s) be terminated after considering the following factors:  The likelihood of the child’s adoption after termination.  The age and health of the child, both at the time of the disposition and, if applicable, at the time the child was removed from the home.  Whether the child has substantial relationships with the parent or other family members, and whether it would be harmful to the child to sever these relationships.  The wishes of the child.  The duration of the separation of the parent from the child. JC-1639 , 08/06 Order Concerning Termination of Parental Rights (Involuntary) §§48.427 and 48.43, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 1 of 2 Order Concerning Termination of Parental Rights (Involuntary) Page 2 of 3 Case No.  Whether the child will be able to enter into a more stable and permanent family relationship as a result of the termination, taking into account the conditions of the child’s current placement, the likelihood of future placements and the results of prior placements. 9. The child is placed in sustaining care because: the child is not likely to be adopted. adoption is not in the best interest of the child. 10. (Complete one of the following only if there is a permanency plan.) Reasonable efforts to achieve the goal(s) of the permanency plan were: made by the department or agency responsible for providing services in the following manner:       not made by the department or agency responsible for providing services. 11. Any parent who has appeared has been informed of the provisions of §§48.432, 48.433 and 48.434, Wisconsin Statutes. 12. Other:       13. The evidence does not warrant the termination of the parental rights of (name):       THE COURT ORDERS: 1a. The parental rights of       is/are terminated. Name of Parent(s) Guardianship and custody of the child: remain with the parent whose rights have not been terminated. are transferred pending adoption to:       Other:       If guardianship or custody is transferred to an agency, this agency shall be responsible for securing the adoption of the child or establishing the child in a permanent family setting. The child’s permanency plan: has been filed is attached . will be filed within 60 days . The provisions of §§48.432, 48.433 and 48.434, Wisconsin Statutes are attached. 1b. The petition to terminate parental rights of (name)       is dismissed. 2. Other:       JC-1639 , 08/06 Order Concerning Termination of Parental Rights (Involuntary) §§48.427 and 48.43, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 2 of 2 Order Concerning Termination of Parental Rights (Involuntary) Page 3 of 3 Case No. BY THE COURT: Circuit Court Judge       Name Printed or Typed       Date JC-1639 , 08/06 Order Concerning Termination of Parental Rights (Involuntary) §§48.427 and 48.43, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 3 of 2