Fill and Sign the Adoption Decree Partner Form

Probate Form No. 139k Adoption Decree-Partner Adoption of a Minor (Page 1 of 2) STATE OF VERMONT PROBATE COURT DISTRICT OF _______________________ IN RE THE ADOPTION OF _________________ DOCKET NO.________________ ADOPTION DECREE - PARTNER ADOPTION OF A MINOR 15A V. S. A. 3-705 The court has considered a petition for adoption of the above named minor filed under Title 15A V. S. A. (The Adoption Act). Based upon the documents on file and the evidence submitted at a hearing held on __________________________, 20 ____, the Court makes the following findings of fact: 1. The original name of the minor adoptee is: _________________________________________________________________ 2. A petition for adoption of th e said minor was filed by _______________________ 3. The said minor was born on __________ __, 19/20_____, at __________________, The time of birth was _________ (A. M./P. M.). 4. The said petitioner ______ is ______ is not married. 5. The said petitioner is a stepparent of the adoptee or is a person who is treated as a stepparent of the adoptee pursuant to Section 4-101(b) of The Adoption Act. 6. Check one: _____ A new birth cer tificate shall not be issued because either the petitioner, or the minor, who is over the age of 14 years of age, ha s requested that a new birth certificate not be issued. _____ A new birth certif icate shall be issued by the Supe rvisor of Vital Records with the following information set forth therein: Father : Name: ____________________________Date of Birth: ______________________ Place of Birth: ______________________ Mother: Maiden Name: ______________________ Name by Which Mother is Known:___________________________ Date of Birth : _____________________ Place of Birth: _____________________ 7. The adoptee shall be known by the name of ______________________________ ________________________________ upon issuance of this decree. 8. The adoptee has been in the physical cust ody of the petitioner for at least 180 days. 9. Notice of this proceeding for adoption has been served or dispensed with as those persons entitled to receive notice under Part 4 of Article 3 of The Adoption Act and Section 4-109 of The Adoption Act. Probate Form No. 139k Adoption Decree-Partner Adoption of a Minor (Page 2 of 2) 10. Each necessary consent, relinquishment, waiver, disclaimer of parental interest, judicial order terminating parental rights, including any order i ssued under Part 5 of Article 3 of The Adoption Act, as required by the Adoption Act, has been filed with the court. 11. Any evaluation required by The Adoption Act has been filed with, and considered by, the court or nas not been required by the court pur suant to Section 4-110 of The Adoption Act. 12. The court has obtained the information require d by Section 203 (d)(7)-(9) of the Adoption Act. 13. Each item required by Section 3-305(a) of Th e Adoption Act, which the court has determined is relevant to this adoption has been filed with th e court or, if any of the said items is unavailable, the person responsible for furnishing it has filed an affidavit explaining its absence. 14. All applicable requirements of The Adopti on Act governing an interstate or inter-country placement for this adoption have been met. 15. The Indian Child Welfare Act, 25 U. S. C. Section 1901 et seq. , is not applicable to this proceedings, or if applicable, its requirements have been met. 16. The accounting and affidavit required by Section 3- 702 of The Adoption Act have been reviewed by the court and the court has denied, m odified, or ordered reimbursement of any payment or disbursement which is not au thorized under Article 7 of The Adoption Act or the court has waived the requirements of Section 3-702 of The A doption Act with respect to this adoption. 17. The petitioner has received each report requi red by Section 2-105 of The Adoption Act. 18. The petitioner is a suitable adoptive parent for the minor. 19. It is in the best interest of the minor to grant the petition for adoption. Upon this decree becoming final: A. The legal relationship between the adoptive parent and the adoptee shall be as set forth in Section 1-104 of The Adoption Act; B. The decree shall not affect: 1. an existing court order for visitati on or communication with a minor adoptee by a person related to the adoptee through the parent who is the adoptive parent’s spouse or deceased spouse; or 2. a court order or agreement for visita tion or communication with a minor adoptee approved by the court pursuant to Section 4-112 of The Adoption Act. THEREFORE, it is hereby ORDERED AND DECREED that the said minor, ________________ _______________________________, is a dopted by, and made the child of, ___________________________________________ and shall hereafter bear the name of ___________________________________________. Dated: _________________________________ _______________________________________ Probate Judge Probate Court, District of _______________________