Fill and Sign the Termination Parental Rights Form 497302402

Form 112 Rev 2/18 The Family Court of the State of Delaware In and For New Castle County Kent County Sussex County PETITION FOR TERMINATION OF PARENTAL RIGHTS Petitioner Respondent Name Name File Number             D.O.B. D.O.B.                   Street Address (including Apt) Street Address (including Apt) Petition Number             P.O. Box Number P.O. Box Number                   City/State/Zip Code City/State/Zip Code             Home Phone Number Work Phone Number Home Phone Number Work Phone Number                         Relation to Child(ren) Relation to Child(ren)             Interpreter needed? Yes No Interpreter needed? Yes No Language       Language       2nd Petitioner (if any) 2nd Respondent (if any) Guardian Ad Litem (if any) 1 of 7 Name Name             D.O.B. D.O.B.             Street Address (including Apt) Street Address (including Apt)             P.O. Box Number P.O. Box Number             City/State/Zip Code City/State/Zip Code             Home Phone Number Work Phone Number Home Phone Number Work Phone Number                         Interpreter needed? Yes No Interpreter needed? Yes No Language       Language       Name       Law Firm       Office Address       City/State/Zip Code       Phone Number       Form 112 Rev 2/18 IN THE INTEREST OF THE FOLLOWING CHILD(REN): ( Complete the table below for each child for which petitioner wants parental rights terminated . Attach additional sheets if necessary.) 1. Complete the table below regarding the child(ren)’s parents (individuals holding parental rights): NAME Address Date of Birth Social Security Number PARENT 1                         PARENT 2                         2. If you do not know the name/address of one or both of the child(ren)’s parents, write in the space provided below what you have done to try to locate him/her/them.                          I have attached to this Petition the following affidavits: Affidavit that a Party’s Address is Unknown Affidavit that Biological Father’s Name is Unknown Affidavit of Non-Disclosure (i.e., Affidavit that a parent knows the name of the biological father but is unwilling to disclose his name) 3. Name(s) of the person(s) or organization having the guardianship, care, control or custody of the child(ren):       Address of person(s) or organization: 4. Name(s) of the person(s) to whom parental rights are sought to be transferred (e.g., proposed adoptive parent(s)) if this Petition is granted:       Address of person(s) or organization if address is different from address of Petitioner(s): 5. Proposed adoptive parent(s)’ relationship to child(ren) if proposed adoptive parent is NOT the Petitioner:       6. I acknowledge the following is true with regards to the child(ren) named in this petition: Adoption of the child is possible, appropriate, and a Petition for Adoption will be filed with this Court. In the case where both parents’ parental rights are sought to be terminated with regard to the child(ren) named in this Petition, the possibility of placement of the child with blood relatives has been explored. Results of these efforts:       2 of 7Child’s Name Child’s Date of Birth Child’s Place of Birth (City, State) Child’s Gender (Check one)                   Male Female                   Male Female                   Male Female                         Form 112 Rev 2/18                   Each birth parent has been advised of the right to make a no-contact declaration pursuant to 13 Del. C. § 962. Termination of Parental Rights is in the best interests of the child. If there are two Respondents, both consent to the termination and transfer of their parental rights and the Consent to Termination and Transfer of Parental Rights for each Respondent is attached to this Petition. If there is only one Respondent, he/she consents to the termination and transfer of his/her parental rights and the Consent to Termination and Transfer of Parental Rights for that Respondent is attached to this Petition. If there are two Respondents, only one Respondent consents to the termination and transfer of his/her parental rights and the Consent to Termination and Transfer of Parental Rights for the consenting Respondent is attached to this Petition. 7. I have attached to this Petition the Grounds for Termination of Parental Rights for each child named above. I have indicated at least one Ground for Termination of Parental Rights for each child named in this petition.             Petitioner Date 2 nd Petitioner (if any) Date Sworn to and subscribed before me: Sworn to and subscribed before me:             Clerk of Court/Notary Public Date Clerk of Court/Notary Public Date 3 of 7 Form 112 Rev 2/18 Affidavit of Truth I/We,       state the information in this Petition for Termination of Parental Rights is true and correct to the best of my/our knowledge. Petitioner 2 nd Petitioner SWORN TO AND SUBSCRIBED BEFORE ME on this date,       . Clerk of Court/Notary 4 of 7 Form 112 Rev 2/18 GROUNDS FOR TERMINATION OF PARENTAL RIGHTS Complete a separate Grounds for Termination of Parental Rights form for each child named in the Petition for Termination of Parental Rights . Thus, if there are 2 children, then 2 Grounds for Termination of Parental Rights forms MUST be completed and attached to the Petition. NAME OF THE CHILD:       Indicate the grounds for Termination of Parental Rights ( Place an “X” next to the grounds that apply ). 1. The parent(s) of the child, or the person(s) or organization holding parental rights over such child agree (consent) that this Petition should be granted. A Consent to Termination and Transfer of Parental Rights is attached to the Petition. 2. Respondent has abandoned the child AND intended to abandon the child as evidenced by the fact that ( Place an “X” next to which situation applies ): a. The child is younger than 6 months old at the time of filing this Petition, Respondent(s) FAILED to:  Pay reasonable prenatal, natal and postnatal expenses in accordance with Respondent’s financial means; AND  Visit regularly with the child; AND  Manifest (show) an ability and willingness to assume legal and physical custody of the child (if the child was NOT in the physical custody of the other parent). b. The child is at least 6 months old at the time of filing this Petition AND for at least 6 consecutive months (6 months in a row) during the year immediately before filing the Petition, Respondent(s) FAILED to:  Make reasonable and consistent payments in accordance with Respondent’s financial means, for support of the child; AND  Communicate or visit regularly with the child; AND  Manifest (show) the ability and willingness to assume legal and physical custody of the child (if the child was NOT in the physical custody of the other parent). c. The child is younger than 6 years old at the time of filing this Petition AND Respondent has placed the child in circumstances leaving the child in substantial risk of injury or death and therefore has manifested (shown) the unwillingness to exercise parental rights. 3. Respondent has abandoned the child BUT did NOT intend to abandon the child because ( Place an “X” next to which situation applies ): a. For 12 consecutive months (12 months in a row) in the 18 months before filing this Petition, Respondent FAILED to:  Communicate or visit regularly with the child; AND 5 of 7 Form 112 Rev 2/18  File or pursue a pending Petition to establish paternity or to establish the right to have contact or visitation with the child; AND  Manifest (show) the ability and willingness to assume legal and physical custody of the child (if the child was NOT in the physical custody of the other parent). AND one of the below applies ( Place an “X” next to all that apply ): The child is not in the legal and physical custody of the other parent and Respondent is not able or willing promptly to assume legal and physical custody of the child, and to pay for the child’s support, in accordance with Respondent’s financial means. Placing the child in Respondent’s legal and physical custody would pose a risk of substantial harm to the physical or psychological well being of the child. Respondent is unfit to maintain a relationship of “parent and child” with the child because of any of the following reasons: i. The circumstances of the child’s conception; OR ii. Respondent’s behavior during pregnancy; OR iii. Respondent’s behavior after the child was born; OR iv. Respondent’s behavior with respect to other children. Failure to grant the Petition for Termination of Parental Rights would be detrimental to the child. 4. The parent(s) of the child or any person(s) holding parental rights over such child are mentally incompetent and therefore, are unable to discharge parental responsibilities in the foreseeable future. ( The Court will select 2 qualified psychiatrists to form an opinion regarding mental incompetence and inability to discharge parental responsibilities. The Court also will appoint a licensed attorney, as Guardian Ad Litem, to represent the alleged incompetent’s interests in the proceeding ). 5. Respondent has been found by a Court of competent jurisdiction to have ( Place an “X” next to all that apply ): a. Committed a felony level offense as described in subchapter II of Chapter 5 of Title 11 against the person in which the victim was a child; b. Aided or abetted, attempted, conspired or solicited to commit a felony level offense as described in subchapter II of Chapter 5 of Title 11 against the person in which the victim was a child; c. Committed or attempted to commit the offense of Dealing in Children as set forth in § 1100 of Title 11. d. Committed the felony level offense of endangering the welfare of a child as set forth in § 1102 of Title 11. 6. The parent(s) of the child, or any person(s) holding parental rights over the child, are not able or have failed to plan adequately for the child’s physical needs or mental and emotional health and development, and 1 or more of the following conditions has been met ( Place an “X” next all that apply ): 6 of 7 Form 112 Rev 2/18 a. If the child is in the care of the Department or a licensed agency : The child has been in the care of the Department of licensed agency for a period of one year, or if the child has come into care as an infant, a period of 6 months, or there is a history of previous placement(s) of this child; OR There is a history of neglect, abuse, or lack of care of the child or other children by Respondent; OR Respondent is incapable of discharging parental responsibilities due to extended or repeated incarceration; OR Respondent is not able or willing to assume promptly legal and physical custody of the child, and to pay for the child’s support, in accordance with Respondent’s financial means; OR Failure to grant the Petition for Termination of Parental Rights will result in continued emotional instability or physical risk to the child. b. If the child is in the care of a stepparent, guardian, permanent guardian or blood relative :  the child has resided in the home of the stepparent, guardian, permanent guardian or blood relative for a period of at least 1 year, or in the case of an infant, a period of 6 months AND  Respondent is incapable of discharging parental responsibilities, and there appears to be little likelihood that Respondent will be able to discharge such parental responsibilities in the near future. 7. Respondent’s parental rights over a sibling (brother, sister, half-brother, half-sister) of the child who is the subject of the Petition have been involuntarily terminated in a prior proceeding. 8. The parent has subjected a child to torture, chronic abuse, sexual abuse, and/or life-threatening abuse. 9. A child has suffered unexplained serious physical injury, near death, or death under such circumstances as would indicate that such injuries, near death, or death resulted from the intentional or reckless conduct or willful neglect of the parent. 7 of 7