Form 112, Petition for Termination of Parental Rights
In the case of wanting to petition for terminating the legal rights that parents have over a minor child, the following petition has to be completed and submitted.
DownloadExtracted Text for Proper Search
TERMINATION OF PARENTAL RIGHTS
F
ORMS
Rev 1/20013001200140018
TERMINATION OF PARENTAL RIGHTS
FORMS
ONLY FILE THE FORMS IN THIS
DO NOT FILE THE FORMS IN THE INSTRUCTION PACKET.
FORMS PACKET.
You must file the following forms:
Petition fo r Termination of Parental Rights
Custody Separate Statement
Information Sheet
Praecipe in Termination of Parental Rights Action
Termination of Parental Rights Order of Reference
Termination of Parental Rights Order for a Hearing
Termination of Parental Rig hts Final Order
Only file these forms if they apply to your situation.
Please see the instruct ion packet for more information:
Affidavit that a Party’s Address is Unknown
Consent to Termination and Transfer of Parental Rights
Affidavit of Non -Military Se rvice
Waiver of Rights Under the Servicemember’s Civil Relief Act
These forms are also located at the Self -Help Centers and on the
Family Court webpage
http://www.courts.state.de/family .
Form 112
Rev 04/14
The Family Court of the State of Delaware
In and For New Castle Kent Sussex County
PETITION FOR TERMINATION OF PARENTAL RIGHTS
Petitioner Respondent
2nd Petitioner (if any) 2nd Respondent (if any)
Guardian Ad Litem (if any)
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
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 neede d? Yes No
Language Language
Name
Street Address (including Apt)
P.O. Box Number
City /State /Zip Code
Home Phone Number Work Phone Number
Attorney for Guardian Ad Litem (if any)
Interpreter needed? Yes No
Language
1 of 7
Form 112
Rev 04/14
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
MOTHER
FATHER
2. If you do not know the name/address of the child(ren)’s mother and/or father, 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 (e.g., Affidavit that mother 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 (i.e. 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 wher e 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.
Child’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
2 of 7
Form 112
Rev 04/14
Results of these efforts:
Each birth parent has been advised of the right to make a no- contact declaration pursuant to 13
Del. C. § 96 2.
Termination of Parental Rights is in the best interes ts 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 2nd Petitioner (if a ny) Date
Sworn to subscribed before me: Sworn to subscribed before me:
Clerk of Court /Notary Public Date Clerk of Court /Notary Public Date
3 of 7
Form 112
Rev 04/14
Affidavit of Truth
I/We, ___________________________________________state the information i n this Petition for
Termination of Parental Rights is true and correct to the best of my/our knowledge.
Petitioner
2nd Petitioner
SWORN TO AND SUBSCRIBED BEFORE ME on this date, __________________________.
Clerk of Court Nota ry
4 of 7
Form 112
Rev 04/14
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 Terminati on 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
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) did FAILED to:
Make reasonable and consistent payments in accordance with R espondent’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 t he other
parent).
c. The child is younger than 6 months 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 (show n) 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 04/14
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 the mother’s 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 04/14
a. If the child is in the care of the Department or a licensed a gency:
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 under the care of a stepparent or blood relative,
the child has resided in the home of the 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 responsi bilities 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 the child to torture, chronic abuse, sexual abuse, and/or life -threatening
abuse.
9. The child has suffered unexplained serious physical injury under such circumstances as would
indicate that such injuries res ulted from the intentional conduct or willful neglect of the parent.
7 of 7
Form 346
Rev. (01/13)
The Family Court of the State of Delaware
In and For New Castle Kent Sussex County
CUSTODY SEPARATE STATEMENT
Petitioner v. Respondent
1. What type of petition are you filing?
2. Who is the child(ren) named in your petition? ( Please provide full name and date of birth)
Child’s Name Date of Birth (mm/dd/yyyy)
3. Have all the children listed above continually resided with one another? Yes No
If you answered “No,” the children have not continually resided with one another; please complete a
Custody Separate Statement for each child.
CURRENT ADDRESS
Address where child(ren) currently resides ** If the address where the child(ren) currently resides is a confidential address in Family Court, DO NOT provide the address on this form. Instead, please mark the fields as CONFIDENTIAL .
Date(s) Child(ren) lived here
State
Zip Code
to present
City
Name of person(s) child(ren) is living with Relationship to child(ren)
4. Durin g the past five years, where have the child(ren) lived? List addresses from the most recent to the oldest.
If the child(ren) is under the age of five years old, end with the first address where the child lived.
PRIOR ADDRESS
Address where child(ren) previously reside d City State Zip Code
Date (s) child(ren) lived there Name of person(s) child(ren) lived with Relationship to child(ren)
to
Person’s current address City State Zip Code
PRIOR ADDRESS
Address where child(ren) previously resided City State Zip Code
Date(s) child(ren) lived there Name of person(s) child(ren) lived with Relationship to child(ren)
to
Person’s current address City State Zip Code
PRIOR ADDRESS
Address where child(ren) previously resided City State Zip Code
Date(s) child(ren) lived there Name of person(s) child(ren) lived with Relationship to child(ren)
to
Person’s current address City State Zip Code
PRIOR ADDRESS
Address where child(ren) previously resided City State Zip Code
Date(s) child(ren) lived there Name of person(s) child(ren) lived with Relationship to child(ren)
to
Person’s current address City State Zip Code
Name Name File Number
1 of 3
Form 346
Rev. (01/13)
5. Check ONE and complete as directed.
No one other than the parties have physical custody, legal custody or visitation rights with the
child(ren).
A person(s) other than the parties have physical custody, legal custody or visitation rights with
the child(ren). If you check this box, complete the information below. Attach additional sheets if
necessary.
PERSON 1
Name of person(s) with physical custody, legal custody or visitation Relat ionship to child(ren)
Person’s current address City State Zip Code
PERSON 2
Name of person(s) with physical custody, legal custody or visitation Relationship to child(r en)
Person’s current address City State Zip Code
6. Select all that apply and complete as directed.
I have not been involved in any other court action for custody and/or visitation of this child(ren).
I have been involved in another court action for custody and/or visitation of this child(ren). If you
check this box, complete the information below . Attach additional sheets if necessary.
ACTION 1
Type of Action (e.g. Custody, Visitation, Other ) Person (who filed the action) State
Court Case Number Date Filed
Result Date of Order
ACTION 2
Type of Action (e.g. Custody, Visitation, Other) Person (who filed the action) State
Court Case Number Date Filed
Result Date of Order
ACTION 3
Type of Action (e.g. Custody, Visitation, Other) Person (who filed the action) State
Court Case Number Date Filed
Result Date of Order
2 of 3
Form 346
Rev. (01/13)
7. Check ONE and complete as dire cted.
I do not know of any other court action such as, Protection From Abuse, Termination of Parental
Rights, Guardianship, Adoption or Paternity involving myself, the other party or the child(ren) that
could affect this petition.
I, the other party or the child(ren) have been and/or are currently involved in another court action
such as, Protection From Abuse, Termination of Parental Rights, Guardianship or Adoption, that
could affect this petition. If you check this box, complete the information below. Attach additional
sheets if necessary.
ACTION 1
Type of Action (e.g. PFA , TPR , Guardianship, Other ) Person (who filed the action) State
Court Case Numb er Date Filed
ACTION 2
Type of Action (e.g. PFA, TPR, Guardianship, Other) Person (who filed the action) State
Court Case Number Date Filed
Petitioner
Sworn to subscribed before me this ______ day of ______________________, _________
Clerk of Court/ Notary Public
3 of 3
Form 240
Rev 10/13
The Family Court of the State of Delaware
INFORMATION SHEET - PLEASE PRINT
Date: File No.:
Please fill in A to K pertaining to you the Applicant (Petitioner).
A. Name:
B. Ad dress:
City/State/Zip:
C. Phone – Home: Work: Cell:
D. Employer & Address:
Hours/Shift
E. Social Security No.: F. Date of Birth:
G. Sex: Race: Height: Weight: Hair: Eyes:
Marks/Scars/Tattoos:
H. Type of motor vehicle operated by you:
I. Driver’s License No.: State of Issue: Expiration Date:
J. Your relatio nship to the Defendant/Respondent:
K. Attorney :
Please fill out the information below in reference to the child(ren) who are involved.
Children
Name Relationship Sex Race D.O.B. Social Security No.
OVER
1 of 2
Form 240
Rev 10/13
Please fill in L to X pertaining to the Defendant/Respondent..(For additional respondents use additional sheets)
L. Defendant/Respondent is a: (Check One) ADULT JUVENILE
M. Name:
N. Address:
City/State/Zip:
O. Phone – Home: Work: Cell:
P. Employer & Address:
Hours/Shift
Q. Social Security No.: R. Date of Birth:
S. Sex: Race: Height: Weight: Hair: Eyes:
Marks/Scars/Tattoos:
T. Driver’s License
State & No.:
U. T ype of vehicle operated by
Defendant/Respondent :
V. Parent’s Name (if a juvenile) :
W. Time when Respondent is usually home :
X. Any additional information about Respondent that may aid the process server in locating him/her to serve this
petition:
____________________________________________________________________________________________________
DIRECTIONS TO RESPONDENT’S RESIDENCE
2 of 2
Form 115
(Rev. 6/10)
The Family Court of the State of Delaware
In and For New Castle Kent Sussex County
, )
)
)
)
)
)
) File No.:
Petitioner
,
v.
Petition No.:
Respondent
PRAECIPE IN A TERMINATION OF PARENTAL RIGHTS ACTION
TO: Clerk of Court,
Please issue a summons and copies of the petition upon the respondent(s) by personal service at
the following addresses in Delaware:
In the event that personal service on one or more of the respondents cannot be effected in
Delaware, and the Court finds that personal service is unlikely, please send a summons by U.S. first class
mail and U.S. registered or certified mail to the home address listed above. In addition, please publish
notice of this action in the following newspapers most likely to give the respondent(s) notice of this action
consistent with the requirements of 13 Del. C.
§ 1107A:
Date Attorney for Petitioner
RESPONDENT NAME HOME ADDRESS WORK ADDRESS
to to Hours Likely to be served:
RESPONDENT NAME HOME ADDRESS WORK ADDRESS
to to Hours Likely to be served:
Respondent Name Local Publication Foreign Publication (if necessary)
Newspaper Address:
Attention:
Form 110T
Dev 11/13
The Family Court of the State of Delaware
In and For New Castle Kent Sussex County
,
)
)
)
)
)
)
)
)
)
File No.: Petitioner
v.
Petition No.:
,
Respondent
ORDER OF REFERENCE FOR TERMINATION OF PARENTAL RIGHTS
Having considered the request of the movant,
IT IS ORDERED, this date:
The foregoing Petition for Termination of Parental Rights having been presented to the Court, and it
Appearing that the Petition has been properly filed;
It is ordered that the
Perform a Social Study and submit a report to the Court as required by D el. C. §1107( b).
Judge
Form 118A
(Rev. 03/10)
The Family Court of the State of Delaware
In and For New Castle Kent Sussex County
, )
)
)
)
)
)
)
)
) File No.:
Petitioner
v.
Petition No.:
,
Respondent
ORDER FOR HEARING FOR TERMINATION OF PARENTAL RIGHTS
AND NOW, TO WIT, the foregoing Petition of having been
read and considered,
IT IS ORDERED that the above matter be set down for a hearing on at
o’clock at which time the Petitioner shall appear to establish that Respondent’s parental rights
in should be terminated and said rights granted to
and Respondent may appear in opposition to the petition and in opposition to the evidence offered in
support thereof.
IT IS FURTHER ORDERED that the Clerk of Court shall cause notice of the time, place and purpose
of the hearing to be served upon at their last known address. If such personal
service cannot be accomplished, then such notice shall be published in
once each week for three consecutive weeks and notice shall be sent to Respondent by regular and
certified mail to the last known address, a copy of the Petition attached thereto.
So Ordered this Date:
Judge
Form 107
Rev. 0 2/1 3
The Family Court of the State of Delaware
In and For New Castle Kent Sussex County
,
)
)
)
)
)
)
)
)
)
File No.: Petitioner
v.
Petiti on No.:
,
Respondent
FINAL ORDER FOR TERMINATION OF PARENTAL RIGHTS
AND NOW, TO WIT, this day of the Petition of
for the Termination of Parental Rights of
having been presented to and duly considered by this Court
and the Court being satisfied from the evidence presented at the hearing on said Petition that the grounds for
Termination of Parental Righ ts as defined by 13 Del.C.§ 1103 have been established
IT IS ORDERED that all parental rights of the said with respect to
be and they are hereby terminated and transferred to
the Petitioner,
PLEASE READ BEFORE CONTINUING PAST THIS POINT:
Only file the following forms if they apply to your situation. Please see the
TERMINATION of PARENTAL RIGHTS instruction packet for more information
If you do not know where the Respondent lives, compl ete:
Affidavit that a Party’s Address is Unknown - (FORM 241)
If the Respondent(s) agreed upon the termination and transfer of their parental
rights, complete :
Consent to Termination and Transfer of Parental Rights – (FORM 140)
If you know the Respondent is
NOT
Affidavit of Non -Military Service – (FORM 405)
in the U.S. military, complete:
If the Respondent is in the military and does not file an Answer or Affidavit of
Appearance, you must have them sign:
Waiver of Rights under the Servicemembers Civil Relief Act
Form 241
Rev 06/1 3
The Family Court of the State of Delaware
In and For New Castle Kent Sussex County
AFFIDAVIT THAT A PARTY’S ADDRESS IS UNKNOWN
BE IT REMEMBERED, that on this day of , , personally
appeared before me, a Notary Public for the State and County aforesaid,
(“Affiant”), who, being by me duly sworn according to law did depose and say:
1. My name is
2. I do not know the current a ddress and/or telephone number, nor do I know anyone who could provide me
with the current address and/or telephone number of . I have
contacted his/her:
(Please check as appropriate) Parent Spouse Employer Other:
3. His/Her last known address and telephone number were:
4. I have had no contact with him/her since .
5. I have been informed of my responsibility to accomplish publication , unless th e Court has approved my
application to proceed In Forma Pauperis, and my failure to do so will result in the petition being d ismissed
after 30 days .
6. The information contained herein is true and correct to the best of my knowledge and belief.
Affia nt
Sworn to subscribed before me this day of ,
Clerk of Court / Notary Public Date
Petitioner Respondent
Name:
Name:
File Number
Petition Number
State of Delaware )
)
County )
Street Address (including Apt)
P.O. Box Number
City /State /Zip Code
Phone Number Information as of: (date)
Form 140
(Rev. 10/12)
1 of 3
The Family Court of the State of Delaware
In and For New Castle Kent Sussex County
CONSENT TO TERMINATE AND TRANSFER PARENTAL RIGHTS
Petitioner v. Respondent
1.
I am the
Mother Father of the following children:
, Born on
, Born on
, Born on
, Born on
2.
I consent to the termination and transfer of my parental rights in my child(ren) named in paragraph 1
above for the purpose of adoption to:
The individual(s) selected by the Dept. of Services for Children, Youth and Their Families or an
approved adoption agency; namely:
(Chosen Adopted Parents:
3. I understand the importance of my decision and fully realize the effects of the termination of my parental
rights in this child (these children).
4. I understand that by terminating my parental rights, all of my rights and obligations to this child (these
children) will be extinguished, except for any arrearages of child support.
5. I understand that after this consent is signed by me, this consent is final and may not be revoked by me
for any reason except:
(a) within fourteen days of executing this consent
, I notify in writing the agency or the individual to
whom the parental rights have been transferred that I revoke my consent;
(b) I comply with the following instruction for revocation
(c) the agency or individual that accepted the consent and I agree to its revocation.
6. I also understand that the Court may set aside my consent if I establish:
(a) By clear and convincing evidence, before a decree of adoption is issued, that my consent was
obtained by fraud or duress; or
(b) By a preponderance of the evidence, that a condition permitting revocation, as expressly
provided for in this consent, as set forth in Paragraph 5(b) above, has occurred.
7.
I understand that this consent may be revoked if a court of competent jurisdiction decides not to
terminate the other parent’s rights to this child (these children).
Name Name File Number
Street Address (including Apt) Street Address (including Apt)
P.O. Box Number P.O. Box Number Petition Number
City/State/Zip Code City/State/Zip Code
D.O.B. D.O.B.
Attorney Name Attorney Name
Form 140
(Rev. 10/12)
2 of 3
8. I have read and/or have had read to me the seven statements set forth on an attachment to this form
and fully understand and agree with each statement.
9. I understand that I have a right to file a written notarized statement with the Department of Health and
Social Services, Division of Vital Statistics, denying the release of any identifying information. I am
aware that, notwithstanding any other provision in the Delaware Code to the contrary, an adoptee 21
years of age or older may obtain a copy of his or her original record of birth from the State Registrar,
even if that record has been impounded, unless the birth parent has, within the most recent three-year
period, filed a written notarized statement with the Department of Health and Social Services, Division of
Vital Statistics, denying the release of any identifying information.
10. I know and understand that I have the right to be served with a copy of the petition for termination of my
parental rights and to attend a hearing on my important decision to terminate my parental rights in my
child(ren). I understand that the Family Court may conduct a hearing on this matter, which I have a right
to attend. I waive my rights to the following:
my right to service of process;
my right to notice of such a hearing;
and my right to attend the hearing.
11. I would like to receive a copy of the final order of the Court
Yes
No
12.
The attorney who is representing me in regards to this consent is ,Esq.
Any questions I have about this consent were answered by the attorney. If I do not have an attorney, I
understand that if I cannot afford an attorney, an attorney may be appointed to represent me at no cost. I
knowingly and voluntarily waive any right I might have to an attorney by checking this box:
13. I understand that I will receive a copy of my signed consent.
14. I have signed this consent voluntarily and of my own free will. I have not been promised nor have I
received any money or anything else of value in exchange for this consent.
at (AM/PM)
Date and Time Signed Signature of Consenting Parent
Printed Name of Consenting Parent
Location of Signing Mailing Address of Consenting Parent
Street Address
P.O. Box Number
City/State/Zip Code
Form 140
(Rev. 10/12)
3 of 3
TERMINATION OF PARENTAL RIGHTS
CONSENT PARTY STATEMENT
I, , the mother father of
who was born on do state that I:
1. Believe that placement of my child for adoption by , would be
In the child’s best interest.
2. Know that the decision to terminate my parental rights is an important one.
3. Know and understand that when my parental rights in my child are terminated, I will no longer be the legal parent
of my child.
4. Know and understand that when I terminate my parental rights in my child that I give up all rights.
5. Know and understand that when I terminate my parental rights in my child and child is adopted, the
child becomes the child of and ,
and as a result the child’s name may be changed.
6. Know and understand that when I terminate my parental rights in my child, my child loses the right to inherit from
me and I lose the right to inherit from him/her. This shall not in any way limit my right to provide for the
disposition of my estate by will.
7. Know and understand that I have the right to be represented by an attorney in this matter, and may be entitled to
have the Court appoint an attorney to represent me for free.
Consenting Party Date
CONFIRMATION STATEMENT
I, the undersigned, hereby certify the following:
1. I am a person authorized to take consents to terminate parental rights under 13 Del. C.
§ 1106(c) because I am
A judge of a court of record;
An individual designated by a judge to take consents;
An employee designated by an agency to take consents;
A lawyer other than a lawyer who is representing an adoptive parent or the agency to which parental rights
will be transferred;
A commissioned officer on active duty in the military service of the United States, if the individual executing
the consent is in the military service; or
An officer of the Foreign Service or a consular officer of the United States in another country, if the
individual executing the consent is in that country.
2. I have explained the contents and consequences of the consent to the consenting party
3. To the best of my knowledge and belief, the consenting party understands that he/she has the right to be
represented by an attorney;
4. To the best of my knowledge and belief, the consenting party read/ was read
5. To the best of my knowledge and belief, the consenting party entered into the consent voluntarily;
6. To the best of my knowledge and belief, the individual is: (check one)
Not a minor; or
Is a minor parent and was advised by a lawyer who is not representing an adoptive parent or the agency to
which parental rights are being transferred;
7. The individual executing the consent signed or confirmed the consent in my presence.
Date Authorized Person
(printed name) Authorized Person
(signature)
Agency:
Address:
Family Court
Form 405
(Rev 01/12)
The Family Court of the State of Delaware
In and For New Castle Kent Sussex County
Petitioner Respondent
Name Name File Numbe r
Street Address Street Address
P.O. Box Numbe r P.O. Box Numbe r Petition Numbe r
City/State/Zip Code City/State/Zip Code
Date of Birth Date of Birth
e Attorney Name Attorney Name
AFFIDAVIT OF NON-MILITARY SERVICE
STATE OF DELAWARE )
) ss.
COUNTY )
BE IT REMEMBERED, that on this date, , personally appeared
before me, a Notary Public for the State of Delaware in the County declared above,
, (“Affiant”), who, being duly sworn by me according to law,
did depose and say:
1. That Affiant is the Petitioner in the above captioned civil action;
2. That Respondent is not in the military service of the United States of America; and
3. That Affiant has made this Affidavit pursuant to the provisions of § 521 of the
Servicemembers Civil Relief Act (50 USCS App. § 501 et seq)
Affiant
Clerk of Court/Notary Public
SWORN TO AND SUBSCRIBED before me this date,
Form 420
(Rev. 01/12)
The Family Court of the State of Delaware
In and For New Castle Kent Sussex County
)
)
) File No.:
Petitioner, )
and )
) Petition No.:
)
Respondent, )
WAIVER OF RIGHTS UNDER THE
“SERVICEMEMBERS CIVIL RELIEF ACT”
STATE OF DELAWARE )
) ss.
COUNTY )
BE IT REMEMBERED, that on this date, , personally appeared
before me, a Notary Public for the State of Delaware in the County declared above,
, (“Affiant”), who, being duly sworn by me according to law,
did depose and say:
1. That Affiant is the Respondent in the above captioned case;
2. That Affiant is active duty in the United States military; and
3. The Affiant waives his/her rights under the “Servicemembers Civil Relief Act” and in doing
so acknowledges that he/she, or his/her attorney, will be required to timely respond to and
appear at all legal proceedings associated with the above captioned case.
Respondent (“Affiant”)
SWORN TO AND SUBSCRIBED before me this date,
Notary Public or Clerk of Court
IMPORTANT INFORMATION REGARDING THE FILING
OF A MOTION
Presenting a motion before the Court requires the completion and
filing of three separate documents.
The Generic Motion document (Form 191) must be filed along with
the Notice of Motion (Form 192) and Form of Order (Form 193)
documents.
Form 191
Rev 1 2/1 3
The Family Court of the State of Delaware
In and For New Castle Kent Sussex County
MOTION FOR
Petitioner Respondent
Name Name File Number
Street Address (including Apt) Street Address (including A pt)
P.O. Box Number P.O. Box Number Petition Number
City/State/Zip Code City/State/Zip Code
Date of Birth Date of Birth
Attorney Name Attorney Na me
Interpreter needed? Yes No Interpreter needed? Yes No
Language Language
A PROCEEDING involving having been filed heretofore in this Court,
Movant hereby moves the Court for and, in
support thereof, alleges the following facts:
SWORN TO AND SUBSCRIBED
before me this date,
Movant/Attorney
Clerk of Court/ Notary Public
I, the Movant, affirm that a true and correct copy of this Motion was placed in the U.S. Mail on this date
, and sent to the other party or atto rney at the address listed on the petition, being
, first class postage
pre-paid.
SWORN TO AND SUBSCRIBED
before me this date,
Movant/Attorney
Clerk of Court/ Notary Public
Form 192
R ev 1 0/10
The Family Court of the State of Delaware
In and For New Castle Kent Sussex County
)
, )
Petitioner ) File No.:
v. )
) Petition No.:
, )
Respondent )
)
)
NOTICE OF MOTION
TO:
PLEASE TAKE NOTICE that the attached Motion for
is herewith presented to the Court for consideration. If you are opposed to this motion, you must
file a written response with the Court within ten (10) days of the service of this motion. If no
response is timely filed, the motion may be decided without further opportunity for you to be heard
on the matter. Family Court Rules, Rule 7(b)( 2).
Dated:
Movant/Attorney
Name and address of Movant/Attorney
Street Address (including Apt) P.O. Box Number
City /State/Zip Code
Form 192i
Rev 05/11
The Family Court of the State of Delaware
(1) In and For New Castle Kent Sussex County
)
(2) ___ ) File No.: __ (4)
Petitioner )
)
v. ) Petition No.: (5)
)
(3) ___ )
Respondant )
)
)
NOTICE OF MOTION
TO: (6)
PLEASE TAKE NOTICE that t he attached Motion (7) is herewith
presented to the Court for consideration. If you are opposed to this motion, you must file a written response
with the Court within ten (10) days of the service of this mot ion. If no response is timely filed, the motion
may be decided without further opportunity for you to be heard on the matter. Family Court Rules, Rule
7(b)(2).
(8 )
Petitioner/Attorney
(9)
(10)
Date Movant/Attorney
Name and address of Movant/Attorney
Street Address P.O. Box Number
City/State/Zip Code
Form 192i
Rev 05/11
FAMILY COURT FORMS INSTRUCTIONAL MANUAL
SUBJECT: Form 192, Notice of Motion (Motion Package)
I. Definition
Form 192 is one of two documents that must accompany a motion at the time it is filed in
Family Court in accordance with Family Court Rule 7(b)(1). Its purpose is to act as an
informational cover sheet which t he movant attaches to the copy of the motion that he/she is
sending to the other party(ies) in the matter. In this way, the other party(ies) are notified that
a motion has been filed in Family Court on a matter in which they have an interest.
II. Preparation
Form 192 is prepared by the movant, or party filing the motion. The original is submitted
along with the motion (Form 191) and the form of order (Form 193) at the time of the filing of
the motion in Family Court. It is the responsibility of the movant to send a copy of all three
forms, completed as appropriate, to the other party(ies). Once it has been filed with the
Court, the motion package is sent to Case Processing and then to a judge/commissioner for
review. The notice of motion must be serv ed according to Family Court Civil Rule 5(c).
III. Components
The following is entered in the appropriately numbered area(s):
1. An "x" to indicate the appropriate county of the Court.
2. The name of the petitioner.
3. The name of the respondent.
4. The Family Court file number (if known).
5. The Family Court petition number (if known).
6. The names and addresses of the parties to the case and of their attorneys, if
applicable.
7. The type of motion being filed.
8. The signature of the att orney/party filing the motion.
9. The date that the motion is being filed.
l0. The name and address of the attorney/party filing the motion.
Form 193
Rev 1 2/1 3
The Family Court of the State of Delaware
In and For New Castle Kent Sussex County
)
, )
Petitioner ) File No.:
v. )
) Petition No.:
, )
Respondent ) In Re:
)
)
ORDER
Having considered the request of the movant, ,
IT IS SO ORDERED , this date:
That
Judge/Commissioner
CC: Petitioner Respondent Petitioner Attorney Respondent Attorney DAG PD
Other DCSE
If you want to remove Form 112, Petition for Termination of Parental Rights from this website please contact us providing the reasons together with this url: https://formsarchive.com/form-112-petition-for-termination-of-parental-rights/