PETITION FOR TERMINATION OF PARENT / CHILD RELATIONSHIP

Revised 11.10.21

PETITION FOR TERMINATION OF

PARENT/CHILD RELATIONSHIP

PINAL COUNTY HOW TO SEVER THE PARENTAL RIGHTS BETWEEN A PARENT AND MINOR CHILD

INSTRUCTIONS AND FORMS

Provided as a Public Service by REBECCA PADILLA

Clerk of the Superior Court

PETITION FOR TERMINATION OF PARENT/CHILD RELATIONSHIP

CHECKLIST

(Arizona Revised Statutes (A.R.S.) Sections (§§) 8-531-544)

You may use the forms and instructions in this packet if . . .

You are a person who has a legitimate interest in the welfare of one or more children, who arepresent in this state (or in another state if placed there by order of this court);

You want a court order to permanently terminate the legal rights, privileges, duties andobligations between one or both parents and one or more of their children (except the right ofthe children to receive support and to inherit from the parent(s));

The parent or parents whose rights you want to terminate have neglected, abused, orabandoned the child through failure to support and maintain reasonable contact, AND/OR

The parent or parents are unable to fulfill the responsibilities of parenting due to mentalillness, lack of mental capacity, or chronic drug or alcohol abuse, and there are no reasonablegrounds to believe those conditions will change in the foreseeable future, AND/OR

The parent(s) are deprived of civil liberties or incarcerated due to conviction of a felony of atype regarded as proving unfitness, such as a violent crime against the other parent oranother child, or the sentence is so long that the children would be deprived of a normalhome for a period of years,

The person thought to be or who claims to be the father did not file a claim of paternity or acourt case to establish paternity as prescribed in A.R.S. Section 8-106,

The parent or parents have signed papers to relinquish their rights to the children to anagency or to consent to adoption.

The identity of the parent is unknown and continues to be unknown following three months ofdiligent efforts to identify and locate the parent.

The parent has had parental rights to another child terminated within the past two years forreasons identical to those to be raised in this case and unable to discharge parental duties forthose same reasons.

You MAY NOT use this packet to cut off or give up your own parental rights.

READ ME:

Consulting a lawyer before filing documents with the court may help prevent unexpected results.

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PETITION FOR TERMINATION OF PARENT / CHILD RELATIONSHIP

How to assemble these documents:

This packet contains general information and instructions to file Petition for Termination of Parent/Child Relationship.

Be sure this packet contains the following documents:

Order Title # of Pages

1 Table of Contents (This Page) 1

2 Information and Instructions: How to fill out the Forms 3

3 Procedures: How to file the Petition 1

5 Petition for the Termination of Parent / Child Relationship 4

6 Severance Cover Sheet 1

7 Notice of Petition to Terminate Parental Rights (A.R.S. §8-106) and Notice of Hearing 2

You have permission to use them for any lawful purpose. These forms shall not be used to engage in the unauthorized practice of law. The Court assumes no responsibility and accepts no liability for actions taken by users of these documents, including reliance on their contents. The documents are under continual revision and are current only for the day they were received. It is strongly recommended that you verify on a regular basis that you have the most current documents. It is strongly recommended that you contact an attorney to assist you in completing these forms if you have any questions.

4 Information on Providing Notice 2

INFORMATION AND INSTRUCTIONS

HOW TO FILL OUT THE FORMS AND GET A HEARING ON PRIVATE TERMINATION OF PARENT-CHILD RELATIONSHIP

(A.R.S. (Arizona Revised Statutes) §§ 8-531, and 8-861, et seq.*) * § means “section”; §§ means “sections”; et seq. means “and the sections that follow”

Where these documents refer to “child”, “children” or “child(ren)” it means as manychildren as are the subject of this process, whether one or more.

PLEASE NOTE: The Court may review a Petition for Termination of Parent-Child Relationship, find that it does not comply with the requirements for a document and dismiss the Petition. If that happens, Petitioner may attempt to fix the deficiencies and file with the Clerk of Court another Petition for Termination of Parent-Child Relationship that complies with all requirements.

PETITION FOR TERMINATION OF PARENT / CHILD RELATIONSHIP:

Petition - A Petition is a key document required for a private request to terminate parental rights. A

Petition must contain a variety of different information as reflected in the “Petition for Termination of

Parent-Child Relationship” form available from the Court.

Among other things, a Petition:

Must reflect that the Petitioner (the person filing the Petition) has a legitimate interest in the child asrequired by Arizona Revised Statutes (A.R.S.) § 8-533(A);

Must include available information about the parent(s) whose parental rights the Petition seeks toterminate;

Must include available information about the children whose parental rights the Petition seeks toterminate;

Must include information about the person or agency who is caring for the children; Must show how the Arizona Superior Court, Pinal County, has power to properly hear the case

(“jurisdiction”), which usually requires that the children have been in Arizona for a period of time; Must include information about grounds for termination as required by A.R.S. § 8-533(B); Must include information about why termination of parental rights is in the best interest of the children,

as required by A.R.S. § 8-533(B); Must include any information about whether the parent(s) or children are enrolled members of any

native American Tribe or Nation; and Should include information regarding who is completing the social study required by A.R.S. § 8-536(A)

or, if the Petitioner is asking that the social study be waived, why waiving that study is in the bestinterest of the children.

A social study must: Be prepared by an appropriate agency or person; Include the circumstances of thepetition, the social history, the present condition of the children and parent, proposed plans for thechildren and other facts pertinent to the parent-child relationship; Address whether or not the parent-child relationship should be terminated; and Contain the information required by A.R.S. § 8-536.

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1. Fill in the name, address, and telephone number of the person filing the form.

2. In the Case Caption list the name(s) of the child(ren) for whom you what to terminate parental rights.

3. Leave the case number blank, this will be completed by personnel at the Office of the Clerk of the SuperiorCourt when you file these documents.

4. Answer all the questions of the Petition for Termination of Parent/Child Relationship. Question (4b) willrequire you to attach proof of paternity [original birth certificate or certified copy of birth certificate,certified copy of the Acknowledgment of Paternity or certified copy of the Order of Paternity].

5. Sign your name on the on the Petitioner line the 2nd page of the Petition before a Notary Public to affirmthat the information on the form is true and correct to the best of your knowledge and belief.

6. Attach to the Petition a copy of the birth certificate(s) for each child(ren) subject to the Petition. If there is apotential adoptive parent, attach a fingerprint clearance card and DCS Central Registry Letter for thepotential adoptive parent to the Petition.

How to fill out the Petition for Termination of Parent/Child Relationship:

SV COVER SHEET:

Cover Sheet - Pinal County Superior Court Administrative Order No. 92-15, the Superior Court requiresthat a "Cover Sheet", which categorizes the cause of action, accompany any new action filed with theSuperior Court in Pinal County.

1. Fill in the Initiating Agency’s name and address in appropriate box, if applicable.

2. Fill in the Petitioner’s name and address in the appropriate box.

3. Fill in the Minor’s name and address in the appropriate box. If there are additional children,continue on the next page.

4. Fill in the Petitioner’s attorney’s name and address in the appropriate box, if applicable.

5. Place a check mark next to the Nature of Action.

6. Sign the document on the signature line provided on the next page.

How to fill out the SV Cover Sheet:

Petition - A Petition is a key document required for a private request to terminate parental rights. A Petitionmust contain a variety of different information as reflected in the “Petition for Termination of Parent-ChildRelationship” form available from the Court.

PETITION FOR TERMINATION OF PARENT / CHILD RELATIONSHIP:

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MAKING COPIES:

Once you have filled out the above forms, Petition (and signature notarized), Severance Cover Sheet, Notice of Petition to Terminate Parent/Child Relationship and Notice of Hearing for Termination make the appropriate set of copies of the documents:

1 set of copies for you, the Petitioner 1 set of copies for Mother, if applicable 1 set of copies for Father, if applicable

The original Petition, Severance Cover Sheet, Notice of Petition to Terminate Parent/Child Relationship and Notice of Hearing will be filed with the Clerk of the Court.

NOTICE OF PETITION TO TERMINATE PARENTAL RIGHTS AND NOTICE OF HEARING:

Notice of Hearing - The Clerk of Court will fill out and provide you with the “Notice of Hearing”at the time of filing the Petition. The Notice provides the date, time and place (location) where the

How to fill out the Notice of Petition to Terminate Parental Rights and Notice of Hearing:

1. In the Case Caption list the name(s) of the child(ren) for whom you want to terminate parental rights.

2. Leave the case number blank, this will be completed by personnel at the Office of the Clerk of the SuperiorCourt when you file these documents.

3. Fill in the name of the parent(s) in the first line, the Petitioner’s in the next appropriate line of thedocument. Fill in the address of the parent(s) in the appropriate line. Complete the date of birth ofthe child(ren) and place of birth in appropriate line.

4. Fill in the name of the Petitioner.

5. On the Notice of Hearing (page 2) fill in your name and the parent’s name in the appropriate first threelines of the document. The deputy clerk at the Office of the Clerk of the Superior Court will complete theremaining part of this document.

Legal Authority

Arizona Revised Statutes Section §§ 8-531 to 8-544

Arizona Rules of Procedure for Juvenile Court § 64-66

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Hearing will be held and other important information.

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STEP 1

STEP 2

STEP 3

PROCEDURES

How to File the Petition for Termination of Parent/Child Relationship

You have filled out the “Petition for Termination of Parent / Child Relationship” and made copies as directed in the instructions provided in this package.

Make sure you take all the forms provided in the packet, so that the deputy clerk can stamp all documents with the case number and judge that the case will be assigned to.

DETERMINE WHERE TO FILE THE COURT FORMS: Please keep in mind that any court hearings will be conducted at the Florence location. You should go to the Court at least 2 hours before closing.

Visit our website for office locations or feel free to give us a call.

Contact Information for all OfficesToll Free: 888.431.1311 • Local: 520.509.3555 or 311

www.coscpinalcountyaz.gov/office.html

PAPERS: Give the completed original initiating documents, Petition for Termination of Parent/Child Relationship, Severance Cover Sheet, Notice of Petition to Terminate Parental Rights and Notice of Hearing, plus the sets of copies to the Deputy Clerk at the customer service counter. The Deputy Clerk will process your Petition and return stamped copies to you.

Make sure to give the Deputy Clerk all other forms provided in the packet so that the Deputy Clerk can stamp the case number and judge’s name. When stamped, the deputy clerk will return the forms to you for you to use at a later time, if applicable.

NOTIFY THE OTHER PARTY: Give legal notice of the “Petition for Termination of Parent/Child Relationship.” After filing original documents, the clerk will return to you the set of copies; one for your records, the other for service on the other party, by:

PLEASE READ THIS CAREFULLY

There are many important steps required to pursue a private Petition for Termination of Parent-Child Relationship and this list is not comprehensive. Failing to comply with each step may result in delays or

the Court dismissing the matter.

• Service by a licensed process serveror Sheriff’s Office

• Service by Acceptance• Service by Publication

* See Information on Providing Notice in this packet *

STEP 4

STEP 5

VERIFICATION OF SERVICE TO THE COURT: Once service is complete, you must file the original proof of service to the court. The Court cannot make a determination regarding your petition until proof of service has been received.

ATTEND HEARING: At the Hearing, the Judge will review pleadings and method of service and if appropriate sign the Order for Termination.

INFORMATION ON PROVIDING NOTICE

Service of Process Must Be Completed Before The Hearing.

A. Service of process is the formal way copies of documents are provided to all individuals and entitiesinvolved in the case. If service of process is not done properly and timely, the court will lackjurisdiction and/or the case may be delayed.

B. Petitioner must serve a copy of the Petition For Termination of Parent-Child Relationship; theNotice of Petition to Terminate Parental Rights and Notice of Hearing on:

1. all parents, and if applicable, each custodian or Indian custodian,

2. Tribe of any children as defined by the federal Indian Child Welfare Act, 25 U.S.C. § 1901,et seq. (and sections that follow);

3. person(s) having legal custody of the children;

4. person(s) standing in loco parentis to the children;

5. guardians ad litem of any party and

6. any other individual or entity that the court orders must be served.

a. All parties must be served as directed by Arizona Rules of Civil Procedure 4, 4.1 and/or 4.2 (asapplicable).

b. Service of process must be timely, meaning it must be completed at least ten (10) daysbefore the Hearing (for service within Arizona) and at least thirty (30) days before theHearing (for service outside of Arizona).PLEASE NOTE: Service of process for cases governed by the Indian Child Welfare Act, 25 U.S.C. § 1901, et. seq., have special timeliness requirements. See, e.g., Arizona Rule of Procedure for Juvenile Court 64(D).

c. Service by publication

i. Service by publication applies when the residence of the person to be served isunknown to the party seeking to serve that person and the party seeking to serveby publication has made a diligent search to find that person. Service by publicationis more complicated than personal service. There are important rules that applyto service by publication. If those rules are not met, the whole process ofservice by publication may need to be started all over, which can result in delays andadded cost.

ii. Service by publication requires literally publishing the Notice of Hearing and astatement as to the manner in which a copy of the Petition ForTermination of Parent-Child Relationship may be obtained at least one (1) timea week for four (4) consecutive weeks in a newspaper published in the countywhere the action is pending. If the last known residence of the person to be served isin Arizona but not in Yavapai County, service by publication also must be madein the county of that last known residence.

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iv. Service by publication is deemed complete thirty days after the first publicationdate.

v. A party serving a person by publication must provide to the court the followingdocuments either at or before the Initial Hearing:

1. A written affidavit or declaration that the residence of the person served bypublication is unknown contained in the “Declaration SupportingPublication” (sometimes referred to as “Affidavit of UnknownResidence”);

2. A written affidavit or declaration that the person to be served bypublication cannot be located even though diligent efforts have beenmade to locate that person contained in the “Declaration SupportingPublication” (sometimes referred to as an “Affidavit of Due Diligence”);

3. A written affidavit showing the manner and dates of the publication (andmailing, if applicable) and the circumstances warranting service bypublication as well as printed copy of the publication. If the residence ofthe person being served is unknown, and therefore no mailing wasmade, the affidavit shall state that.

d. Notice and appearance may be waived by an individual or entity involved in the case. Awaiver of notice and appearance must contain language explaining themeaning and consequences of the waiver and the termination of parental rightspursuant to A.R.S. § 8-535(C). Unless done in court, a waiver of notice andappearance must be signed by the individual or entity agreeing to the waiver andnotarized or attested by two or more credible witnesses who are at least eighteen(18) years old.

di. A consent to adoption must comply with certain specified requirements, includingA.R.S. §§ 8-106 and 8-107. PLEASE NOTE: In Arizona, if a proper consent hasbeen obtained, a person seeking to adopt a child may proceed directly toadoption without filing a Petition for Termination of Parent-Child Relationship. Inthat case, the Pinal County Attorney provides representation in uncontested adoptionspursuant to A.R.S. § 8-127.

dii. A copy of any relinquishment or consent shall be attached to the Petition pursuant toA.R.S. § 8-534(C).

iii. Where the party seeking to serve a person by publication has an address for theperson to be served, before the first date of publication, a copy of the Petition ForTermination of Parent-Child Relationship; Notice of Hearing must be mailed, postageprepaid, to that person at that person’s last known place of residence.

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SUPERIOR COURT OF ARIZONA PINAL COUNTY

CASE NUMBER: SV2

PETITION FOR THE TERMINATION OF PARENT / CHILD RELATIONSHIP

Honorable: _____________________________

IN THE MATTER OF THE SEVERANCE OF:

________________________________________Minor Child/Children

THE PETITIONER ALLEGES AS FOLLOWS:

1. That the name(s) and residence of the Petitioner(s) is/are:

Name: ___________________________________________________________________ Address: _________________________________________________________________

County of Residence: _______________________________________________________ Relationship to Minor Child(ren): ______________________________________________

2. That the name(s), date(s) of birth, place(s) of birth, and residence(s) of the minor child(ren) is/are:

a. Name: _________________________________________ Date of Birth: _________________________________ The child is: □ Male □ FemaleAddress: ___________________________________________________________________County of Residence: _____________________________ Place of Birth: ______________Is this child Native American: □ Yes □No If yes, which Tribe/Nation: __________________

b. Name: _________________________________________Date of Birth: _________________________________ The child is: □ Male □ FemaleAddress: ___________________________________________________________________County of Residence: _____________________________ Place of Birth: ______________Is this child Native American: □ Yes □No If yes, which Tribe/Nation: __________________

c. Name: _________________________________________Date of Birth: _________________________________ The child is: □ Male □ FemaleAddress: ___________________________________________________________________County of Residence: _____________________________ Place of Birth: ______________Is this child Native American: □ Yes □No If yes, which Tribe/Nation: __________________

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Represented by Attorney

Name of Person Filing: Street Address: City, State, Zip Code: Telephone Number: Email Address: ATLAS Number (if applicable) Representing Self (No Attorney) or If Attorney, Bar Number:

ARLopez

Cross-Out

3. That the minor child(ren) is/are present in the State of Arizona: □Yes or □No.If yes, how long has the child(ren) resided in Arizona?_____________________________________If less than six months, in which state did the child(ren) previously reside?______________________If no, explain:

4. That the names, addresses, and dates of birth of the parents, if known are:a. Name of Mother of Minor Child(ren): _________________________________________

Address: ________________________________________________________________Date of Birth: ____________________________________________________________

b. Name of Father of Minor Child(ren): _________________________________________Address: ________________________________________________________________Date of Birth: ____________________________________________________________Paternity has been established by the Father: □Yes or □No. If Yes, please indicate howpaternity was established:

□ Father’s name appears on the child(ren)’s birth certificate I have attached the required original birth certificate or certified copy

□ Acknowledgment of Paternity

5. That the person(s) or agency having legal decision-making (also known as “custody”) of the minorchild(ren) is/are:_______________________________________________________________________________________________________________________________________________________________________________________________________________________Court orders granting legal decision-making (custody) of the minor child(ren) were issued by________________________________ on ____________ in case number __________________.

Is or has there ever been any other court case(s) concerning the child(ren)? □Yes □NoIf yes, please explain: ________________________________________________________________________________________________________________________________________.

6. That the ground for termination of the parent-child relationship under A.R.S. §8-533(B) that apply tothe Mother are: (check all that apply)


□

I have attached the required certified copy of the Acknowledgment of Paternity□ Court Order in case number ________________________________________

I have attached the required certified copy of the Order□ Mother and Father were married at the time of the child(ren)’s birth or conception

□

Name: _________________________________________Date of Birth: _________________________________ The child is: □ Male □ Female Address: ___________________________________________________________________ County of Residence: _____________________________ Place of Birth: ______________ Is this child Native American: □ Yes □No If yes, which Tribe/Nation: __________________

Name: _________________________________________Date of Birth: _________________________________ The child is: □ Male □ Female Address: ___________________________________________________________________ County of Residence: _____________________________ Place of Birth: ______________ Is this child Native American: □ Yes □No If yes, which Tribe/Nation: __________________

□

d.

e.

(Specify which Court) (Date)

Mother Father

□ □

□ □

□ □

□ □

□ □

□ □

□ □

7. That termination of the parent-child relationship is in the best interest of the child(ren) for thefollowing reason(s): (check all that apply)

□ There is a plan for adoption of the child(ren). The potential adoptive parent(s) is/are:

______________________________________________________________________

□ Terminating the parent-child relationship would benefit that child(ren). Please explain.

______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________


□ □

□ □

That the parent has abandoned the child. A.R.S. §8-533(B)(1).

That the parent has neglected or willfully abused a child. This abuse includes serious physical or emotional injury or situations in which the parent knew or reasonably should have known that a person was abusing or neglecting a child. A.R.S. §8-533(B)(2).

That the parent is unable to discharge parental responsibilities because of mental illness, mental deficiency or a history of chronic abuse of dangerous drugs, controlled substances or alcohol and there are reasonable grounds to believe that the condition will continue for a prolonged indeterminate period. A.R.S. §8-533(B)(3).

That the parent is deprived of civil liberties due to the conviction of a felony if the felony of which that parent was convicted is of such a nature as to prove the unfitness of that parent to have future custody and control of the child, including murder of another child of the parent, manslaughter of another child of the parent or aiding or abetting or attempting, conspiring or soliciting to commit murder or manslaughter of another child of the parent, or if the sentence of that parent is of such a length that the child will be deprived of a normal home for a period of years. A.R.S. §8-533(B)(4).

That the potential father failed to file a paternity action within thirty days of completion of service of notice as prescribed in §8-106, subsection G. A.R.S. §8-533(B)(5).

That the putative father failed to file a notice of claim of paternity as prescribed in § 8-106.0. A.R.S. §8-533(B)(6).

That the parents have relinquished their rights to a child to an agency or have consented to the adoption. A.R.S. §8-533(B)(7).

That the identity of the parent is unknown and continues to be unknown following three months of diligent efforts to identify and locate the parent. A.R.S. §8-533(B)(9).

That the parent has had parental rights to another child terminated within the preceding two years for the same cause and is currently unable to discharge parental responsibilities due to the same cause. A.R.S. §8-533(B)(10).

□ Continuing the parent-child relationship would cause a detriment to the child(ren). Pleaseexplain.

______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________

WHEREFORE it is requested that the Court set that matter for hearing and that the parent/child relationship be severed.

_______________________________________ _____________________ Date Petitioner Signature

State of Arizona )

County of _______________ )

SUBSCRIBED AND SWORN TO before me this __________ day of _____________________, 20____

by ________________________________.

Commission Expires: ______________________________________ Notary Public


_______________________________________ _____________________ Date Petitioner Signature

State of Arizona )

County of _______________ )

SUBSCRIBED AND SWORN TO before me this __________ day of _____________________, 20____

by ________________________________.

Commission Expires: ______________________________________Notary Public

)

)

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Arizona Superior Court, Pinal County

Severance Cover Sheet

ASSIGNED TO HON. CASE NUMBER SV2

INITIATING AGENCY’S NAME and ADDRESS

Name: Address:

City/State/Zip:

Telephone:

MINOR’S NAME and ADDRESS

Name:

Address:

City/State/Zip:

Social Security Number:

DOB:

PETITIONER'S NAME and ADDRESS

Name:

Address:

City/State/Zip:

Telephone:

ATTORNEY’S NAME and ADDRESS

Name:

State Bar #:

Address:

City/State/Zip:

Telephone

Names of Additional Minors Soc. Sec. # Birth Dates of Additional Minors

To the best of my knowledge, all information is true and correct

________________________________________________________ Attorney / ProPer Signature

(Pro Per is a person representing themselves without an attorney)

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SUPERIOR COURT OF ARIZONA PINAL COUNTY

CASE NUMBER: SV 2

NOTICE OF PETITION TO TERMINATE PARENTAL RIGHTS (Pursuant To A.R.S. §8-106) AND NOTICE OF HEARING

HONORABLE:

(parent(s))

that you have been

, the Petitioner(s), in .

, the Petitioner, is seeking to terminate the parent-child relationship

2. Under sections 8-106 and 8-107, Arizona Revised Statutes, you have the right to consent or withhold consent tothe adoption.

3. Your written consent to the adoption is irrevocable once you give it.

4. If you withhold consent to the adoption, you must initiate paternity proceedings under title 25, chapter6, article 1, Arizona Revised Statutes, and serve the mother within thirty days after completion of service ofthis notice.

5. You have the obligation to proceed to judgment in the paternity action.

6. You have the right to seek legal decision-making.

7. If you are established as the child's father, you must begin to provide financial support for the child.

8. If you do not file a paternity action under title 25, chapter 6, article 1, Arizona Revised Statutes, and do notserve the mother within thirty days after completion of the service of this notice and pursue the actionto judgment, you cannot bring or maintain any action to assert any interest in the child.

9. The Indian child welfare act may supersede the Arizona Revised Statutes regarding adoption and paternity.

10. You may wish to consult with an attorney to assist you in responding to this notice.

IN THE MATTER OF THE SEVERANCE OF:

Minor Child /Children

NOTICE is given to

residing at identified by as a parent of a child to be born, or born on

YOU ARE INFORMED OF THE FOLLOWING:

1.

(Parent)(Child/Children)between______________________________________________ and _____________________________.

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NOTICE OF HEARING

A petition to terminate the parent / child relationship between:

;

, the Petitioner herein states: having been filed by

NOTICE IS HEREBY GIVEN that the Petition for Termination of Parent/Child Relationship is set for hearing

on the ______ day of _______________________, at _____________ a.m. / p.m. in the Superior Court, Pinal County

Courthouse, located at 971 Jason Lopez Circle, Bldg. A, Florence, Arizona 85132, and all persons interested in the

matter are notified then and there to appear and show cause, if any they have, why said Order Terminating the

Parent- Child Relationship should not be granted.

You have a right to appear as a party in this proceeding. The failure of a parent to appear at the

initial hearing, the pretrial conference, the status conference or the termination adjudication hearing may

result in an adjudication terminating the parent-child relationship of that parent.

DATED this day of , 20

By (Deputy Clerk)

REBECCA PADILLA Clerk of the Superior Court

and(Parent) (Child/Children)

PETITION FOR TERMINATION OF PARENT / CHILD RELATIONSHIP

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