Petition ForTermination Of Parent Child Relationship

Name of Person Filing: Street Address: City, State, Zip Code: Telephone Number: Email Address: ATLAS Number (if applicable) Representing Self (No Attorney) If Attorney, Bar Number: or Represented by Attorney SUPERIOR COURT OF ARIZONA PINAL COUNTY IN THE MATTER OF THE SEVERANCE OF: CASE NUMBER: SV 2 PETITION FOR TERMINATION OF PARENT / CHILD RELATIONSHIP Minor Child / Children HONORABLE: THE PETITIONER ALLEGE AS FOLLOWS: 1. That the names and residence of the Petitioner(s) is: Name: Address: 2. That the name(s), date of birth(s) residence and place(s) of birth and of the minor child(ren) is / are: a. Name: Date of Birth: Address: County of Residence: Place of Birth: b. Name: Address: County of Residence: Name: Address: County of Residence: Name: Address: County of Residence: Date of Birth: Place of Birth: Date of Birth: Place of Birth: Date of Birth: Place of Birth: c. d. Page 1 of 4 SV_PTPCR_COSCPinal_04.22.13 Use only most current version American LegalNet, Inc. www.FormsWorkFlow.com 3. That the minor child(ren) is /are present in the State of Arizona: Yes or No. If no, Explain: 4. That the relationship of the Petitioner(s) to the minor child(ren is: 5. That the names, addresses, and the dates of birth of the natural parents, if known are: Name of Mother of Minor Child(ren): Address: Date of Birth: Name of Father of Minor Child(ren): Address: Date of Birth: 6. That the person or agency having legal decision-making of the minor child(ren): 7. That the grounds for termination of the parent ­ child relationship under A.R.S. §8-533(B) are: (Check All That Apply) The Mother Father 1. That the parent has abandoned the child. 2. 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. 3. 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. 4. 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 nature as to prove the unfitness of that parent to have future legal decision-making 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 length that the child will be deprived of a normal home for a period of years. 5. That the potential father failed to file a paternity action within thirty days of completion of service of notice as prescribed in section 8-106, subsection G. 6. That the putative father failed to file a notice of claim of paternity as prescribed in section 8106.01. Page 2 of 4 SV_PTPCR_COSCPinal_04.22.13 Use only most current version American LegalNet, Inc. www.FormsWorkFlow.com 7. That the parents have relinquished their rights to a child to an agency or have consented to the adoption. 8. That the child is being cared for in an out-of-home placement under the supervision of the juvenile court, the division or a licensed child welfare agency, that the agency responsible for the care of the child has made a diligent effort to provide appropriate reunification services and that one of the following circumstances exists: (a) The child has been in an out-of-home placement for a cumulative total period of nine months or longer pursuant to court order or voluntary placement pursuant to section 8-806 and the parent has substantially neglected or willfully refused to remedy the circumstances that cause the child to be in an out-of-home placement. (b) The child who is under three years of age has been in an out-of-home placement for a cumulative total period of six months or longer pursuant to court order and the parent has substantially neglected or willfully refused to remedy the circumstances that cause the child to be in an out-of-home placement, including refusal to participate in reunification services offered by the department. (c) The child has been in an out-of-home placement for a cumulative total period of fifteen months or longer pursuant to court order or voluntary placement pursuant to section 8806, the parent has been unable to remedy the circumstances that cause the child to be in an out-of-home placement and there is a substantial likelihood that the parent will not be capable of exercising proper and effective parental care and control in the near future. 9. 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. 10. 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. 11. That all of the following are true: (a) The child was cared for in an out-of-home placement pursuant to court order. (b) The agency responsible for the care of the child made diligent efforts to provide appropriate reunification services. (c) The child, pursuant to court order, was returned to the legal decision-making of the parent from whom the child had been removed. (d) Within eighteen months after the child was returned, pursuant to court order, the child was removed from that parent's legal decision-making, the child is being cared for in an out-ofhome placement under the supervision of the juvenile court, the division or a licensed child welfare agency and the parent is currently unable to discharge parental responsibilities. Page 3 of 4 SV_PTPCR_COSCPinal_04.22.13 Use only most current version American LegalNet, Inc. www.FormsWorkFlow.com 8. That Petitioner(s) intend to petition for the adoption of minor child(ren) or is only terminating parental rights of absent parent: Child's Name: Child's Name: Child's Name: Child's Name: is the natural parent and WHEREFORE it is requested that the Court set the matter for hearing and that the parent / child(ren) relationship be severed. Date Signature State of Arizona ) ) County of ) SUBSCRIBED AND SWORN TO before me this by Name of Signer Commission Expires day of