DHS-5308, Verification of Court ... - State of Michigan



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|VERIFICATION OF COURT ACCEPTANCE OF ADOPTION PETITION |

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|This form is verifying that a complete adoption petition and the required appropriate supporting documents have been accepted by the court for the following child: |

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|Child’s Name |      |

|Child’s Date of Birth |      |

|Adoptive Parent(s) |      |

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|Adoption Agency Name |      |

|Adoption Agency Address |      |

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|Adoption Worker’s Name |      |

|County Court |      |

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|By my signature, I verify that the adoption petition and the required appropriate supporting documents were filed with the court for the above-named child       (date).|

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|Adoption Worker Signature | |Date |

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|By my signature, I verify that the adoption petition and the required appropriate supporting documents were filed with the court for the above-named child and accepted |

|by the court on       (date). |

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|Court Representative Signature | |Title | |Date |

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|The Michigan Department of Health and Human Services (MDHHS) does not discriminate against any individual or group because of race, religion, age, national origin, |

|color, height, weight, marital status, genetic information, sex, sexual orientation, gender identity or expression, political beliefs or disability. |

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State of Michigan

department of HEALTH AND human services

Lansing

GRETCHEN WHITMER

governor

ROBERT GORDON

director

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