Petition to Adopt Minor By A Parent’s Partner

This form is to be used in drafting a Petition to adopt a minor by a parent’s partner in the State of Vermont.

Download

Recommended

Preview

10/04 SML
FORM 131C. PETITION TO ADOPT MINOR BY A PARENT’S PARTNER
STATE OF VERMONT PROBATE COURT
DISTRICT OF ______________ DOCKET NO. ____________________________
IN RE: ADOPTION OF ______________________________________
PETITION TO ADOPT MINOR BY PARENT’S PARTNER
15A V.S.A. § 4-107

1. My Full Name Is: ________________________________________________________
2. My Date and Place of Birth Are: ____________________________________________
(Date) (Place)
3. The City or Town Where I Reside is: ________________________________________
4. My Mailing Address Is: ______________________________________________
______________________________________________
______________________________________________
5. The Length of Time I Have Lived at My Current Residence Is: ___________________
6. My Relationship to the Minor Child Being Adopted Is: __________________________
7. My Occupation is: _______________________________________________________
8. My Approximate Income Is: _______________________________________________
9. I State That I Do Have the Facilities and Resources to Provide for the Care and Support
of the Minor.
10. My Partner’s Occupation Is: _______________________________________________
11. My Partner’s Approximate Income Is: _______________________________________
12. Full Birth Name, Or Legal Name of Minor Who Is Being Adopted:
______________________________________________________________________
13. Name by Which Minor Will be Known After Adoption:
______________________________________________________________________
14. Sex of the Minor Who Is Being Adopted: _____________________________________
15. Date of Birth and Time (or Approximate Time) of Birth of Minor Who Is Being Adopted:
______________________________________________________________________ 16. Place of Birth of Minor Who Is Being Adopted: ________________________________
17. The Minor ____ Is or ____ Is Not (Check One) An Indian Child as Defined in the Indian
Child Welfare Act, 25 U.S.C. § 1901 et seq.
18. The Following Is A Description And Estimate of Value of Any Known Property of the
Minor:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
19. I state that to the best of my knowledge and belief, any law governing interstate or
intercountry placement which applies to this adoption has been complied with.
20. Names and Mailing Addresses of the Biological Parents of the Person to be Adopted:
Name Mailing Address
1. ________________________________ ___________________________________
___________________________________
2. ________________________________ ___________________________________
___________________________________
21. The Following Persons Have Executed a Consent, Relinquishment, Or A Disclaimer of
Parental Interest With Respect to This Adoption:
Name Relationship Type of Document Executed
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
22. A Consent or Relinquishment From Each of the Following Persons, Whose Parental
Relationship with the Minor Has Not Been Terminated, May Be Required:
Name Relationship
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
23. With Respect to the Persons Named in section 22, The Following Facts And
Circumstances May Excuse The Lack of Their Consents:
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
24. I Have Either:
____ Filed a previous Petition to Adopt in another court. If so, the disposition of the
Petition was as follows:
_______________________________________________________________________
___________________________________________________________________________ Not filed a previous Petition to Adopt in another court.
25. The Following Is A Description of Any Previous Court Order or Court Proceeding
Known to Me Concerning Child Support for the Minor or Concerning Custody of or
Visitation With the Minor (Use Additional Sheets, If Necessary):
Name of Court Docket Number Type of Proceeding
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
26. My Partner and I are joined in a Civil Union: ____ Yes ____ No
27. If my Partner and I are currently joined in Civil Union:
A. The Date of My Civil Union Was: __________________ .
B. The Place of My Civil Union Was: __________________ .
C. The Place of Birth of My Partner Was: __________________ .
D. The Date of Birth of My Partner Was: __________________ .
E. If My Partner Is Incompetent, the Date When a Court Declared Him or Her
Incompetent Was: __________________ .
28. If My Partner is Deceased:
A. The Date of His or Her Death Was: __________________ .
B. The Place of His or Her Death Was: __________________ .
C. The Cause of His or Her Death Was: __________________ .
29. The Minor Child Has been Residing with Me and My Partner Since: ________________
__________________ .
30. If the Minor Is Not in My and My Partner’s Physical Custody:
A. The Reason Why We Do Not Have Physical Custody Is As Follows:
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
B. The Date We Intend To Obtain Physical Custody Is: __________________________
31. My Partner And I Have Had Legal Custody of the Minor Since ____________________
The Circumstances Under Which We Obtained Legal Custody Are As Follows:
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
32. I request that I be permitted to adopt the minor as my child.
33. I Request the Following Additional Relief From the Court:
_______________________________________________________________________
_______________________________________________________________________
34. I have attached to this petition an explanation of why any of the information requested inthis petition has not been provided by me.
35. Names and Mailing Addresses of Living Maternal Grandparents:
__________________ _______________________________________________
_______________________________________________
__________________ _______________________________________________
_______________________________________________
36. Names and Mailing Addresses of Living Paternal Grandparents:
__________________ _______________________________________________
_______________________________________________
__________________ _______________________________________________
_______________________________________________
37. A Home Study:
____ is being prepared. The name and address of the preparer is:
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
38. If a Home Study is Not Being Prepared, Are You Going to File a Request With This
Court for Waiver of the Home Study?
____ Yes ____ No
Dated at ________________________________________ , this ________ day of
______________ , ______ .

________________________________________
Petitioner

Subscribed and Sworn to this ________ day of ______________ , _____.
________________________________________
Notary Public
IF PETITIONER IS MARRIED, PETITIONER’S SPOUSE MUST SIGN THE FOLLOWING,
UNLESS THE SPOUSE HAS BEEN JUDICIALLY DECLARED INCOMPETENT:
I, ________________________________________, the spouse of the petitioner, consent
to the filing of this petition.
________________________________________
(signature)
________________________________________
(printed name)