Adoption Forms

The forms available through this page are for use only in conjunction with the filing of an adoption proceeding in Berrien County Trial Court - Family Division.

Department of Human Services

The below links are directly to the forms on the DHS website.

• FIA 1917 (PDF) – Adult Former Sibling Statement to Release Information to Adult Adoptee
• FIA 1919 (PDF) – Parent’s Consent/Denial to Release Information to Adult Adoptee
• FIA 1920 (PDF) – Release of Information Authorization Adult Adoptee
• FIA 1925 (PDF) – Request by Adult Adoptee for Identifying Information
• DHS Pub 439 (PDF) – Release of Information from Michigan’s Adoption Records

State Court Administrative Office (SCAO) Forms

The below SCAO forms are completed with information appropriate for filing in Berrien County.  

•  JC 07 (PDF) – Appearance of Attorney / Guardian Ad Litem / Lawyer–Guardian Ad Litem
• PCA 301 (PDF) – Petition for Adoption
• PCA 301a (PDF) – Petition for Direct Placement Adoption
• PCA 302 (PDF) – Supplemental Petition and Affidavit to Terminate Parental Rights of Non–Custodial Parent
• PCA 305 (PDF) – Release of Child by Parent
• PCA 305a (PDF) – Release of Child by Guardian
• PCA 307 (PDF) – Consent to Adoption by Adoptee
• PCA 308 (PDF) – Consent to Adoption by Parent
• PCA 308a (PDF) – Consent to Adoption by Guardian
• PCA 310 (PDF) – Petition for Hearing to Identify Father and Determine or Terminate His Rights
• PCA 311 (PDF) – Notice of Hearing to Identify Father and Determine or Terminate His Rights
• PCA 312 (PDF) – Order Terminating Rights of Father Without Release or Consent
• PCA 313 (PDF) – Petition to Issue Notice of Intent to Release or Consent
• PCA 314 (PDF) – Notice of Intent to Release or Consent
• PCA 315 (PDF) – Declaration of Inability to Identify / Locate Father
• PCA 316 (PDF) – Notice to Putative Father and Custody Statement
• PCA 318 (PDF) – Order Terminating Parental Rights after Release or Consent
• PCA 320 (PDF) – Order Placing Child After Consent
• PCA 322 (PDF) – Order Committing to Agency or Department
• PCA 329 (PDF) – Statement of Parent/Guardian Authorizing Temporary Placement of Child for Adoption
• PCA 330 (PDF) – Statement of Parent/Guardian Transferring Physical Custody of Child for Adoption
• PCA 331 (PDF) – Statement of Child Placing Agency Transferring Physical Custody of Child for Adoption
• PCA 332 (PDF) – Statement of Prospective Adoptive Parent Transferring Physical Custody of Child for Adoption
• PCA 333 (PDF) – Follow–up Report After Temporary Placement of Child for Adoption
• PCA 338 (PDF) – Statement to Accompany Release
• PCA 339 (PDF) – Statement to Accompany Consent in Direct Placement
• PCA 340 (PDF) – Statement of Identifying Information
• PCA 341 (PDF) – Final Order Allowing Fees and Costs
• PCA 342 (PDF) – Petition and Order to Appoint Confidential Intermediary
• PCA 345 (PDF) – Statement of Services Performed by Agency / Family Independence Agency
• PCA 346 (PDF) – Statement of Services Performed by Attorney
• PCA 347 (PDF) – Petitioner’s Verified Accounting
• PCA 348 (PDF) – Parent’s or Guardian’s Verified Accounting for Adoption Release or Direct Placement Consent
• PCA 350 (PDF) – Motion and Order for Delayed Registration of Foreign Birth