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PCA 339

Statement to Accompany Consent in Direct Placement

Michigan · Michigan State Court Administrative Office · Effective February 1, 2015

This form is a statement that a parent or guardian uses to show they agree to let a child be placed directly with a family. It includes several statements about the parent's understanding and agreements related to the adoption.

The court describes it as: Court rule / statute: MCL 710.44(5)

Open the official PDFfrom Michigan State Court Administrative Office

Where this fits in a case

Motions

Stage: Motions

This form is used when a parent or guardian is consenting to a direct placement of an adoptee, as required by Michigan law.

Usually filed by the person starting the case.

Common questions

Who fills out this form?
The parent or guardian of the adoptee fills out this statement. It also has a section for a witness signature.
Does this form require a fee?
The provided text does not mention any filing fees for this form.
What does the parent agree to?
The parent agrees to certain things, such as keeping the child-placing agency informed about health problems and keeping their address current.

Revision history

No changes recorded since we started tracking this form on October 9, 2026. The current version took effect February 1, 2015.

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