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Adoptive Family Assessment and addendum(s) with supervisory approval noted. FORMCHECKBOX Copy of the child s birth certificate or other verification of birth FORMCHECKBOX Legal documentation (Copies of at least 1 of the following legal forms must be included)A copy of the Order Terminating Parental Rights, Commitment to DHS (JC63) The applicable legal documents committing a child to DHS following a voluntary release (PCA 305, 306, 312, 318, 322) Combination of a. and b. above Order committing a child to MCI, following a disrupted adoptionPlacement Agency and Address FORMTEXT      Signature of Adoption WorkerDateTelephone Number FORMTEXT      ( FORMTEXT    )  FORMTEXT      Signature of Adoption Supervisor Approving this PlacementDate FORMTEXT      Department of Human Services (DHS) will not discriminate against any individual or group because of race, religion, age, national origin, color, height, weight, marital status, sex, sexual orientation, gender identity or expression, political beliefs or disability. If you need help with reading, writing, hearing, etc., under the Americans with Disabilities Act, you are invited to make your needs known to a DHS office in your area.AUTHORITY: MCL 710.21 et. Seq. and P.A. 280 of 1939. RESPONSE: Required. PENALTY: Adoption delay.     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