Fill and Sign the Adoption Decree Partner Adoption of a Minor Form 139k Vermont

STATE OF VERMONT PROBATE COURT DISTRICT OF ____________ In Re the Estate of: ) DOCKET No. __________ ) __________________ ) , Deceased ) ) ) LATE OF ) ) __________________ . ) ) ) 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 fact: 1. The original name of the minor adoptee is: ________________________________________ 2. A petition for adoption of the said minor was filed by ____________________ on _______________ , 20       . 3. The said minor was born on __________ , 20       at ______________________________ The time of birth was __________ (A.M./P.M.). 4. The said petitioner is 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 certificate shall not be issued because either the petitioner, or the minor, who is over the age of 14 years of age, has requested that a new birth certificate not be issued. A new birth certificate shall be issued by the Supervisor of Vital Records with the following information set forth therein: - 1 - 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 the issuance of this decree. 8. The adoptee has been in the physical custody of the petitioner for at least 180 days. 9. Notice of this proceeding for adoption has been served or dispensed with as to those persons entitled to receive notice under Part 4 of Article 3 of The Adoption Act and Section 4-109 of The Adoption Act. 10. Each necessary consent, relinquishment, waiver, disclaimer of parental interest, judicial order terminating parental rights, including any order issued 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 has not been required by the court pursuant to Section 4-110 of The Adoption Act. 12. The court has obtained the information required by Section 2- 203(d)(7) - (9) of The Adoption Act. 13. Each item required by Section 3-305(a) of The Adoption Act, which the court has determined is relevant to this adoption has been filed with the 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 Adoption Act governing an interstate or intercountry placement for this adoption have been met. - 2 - 15. The Indian Child Welfare Act, 25 U.S.C. Section 1901 et seq., is not applicable to this proceeding, or, if applicable, 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, modified, or ordered reimbursement of any payment or disbursement which is not authorized under Article 7 of The Adoption Act or the court has waived the requirements of Section 3-702 of the Adoption Act with respect to this adoption. 17. The petitioner has received each report required 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 a 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 visitation 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; 2. a court order or agreement for visitation 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 adopted by, and made the child of, ____________________ and shall hereafter bear the name of ____________________ . Dated at ______________ this ____ day of ______________, 20___. ___________________________________________________________ (signature) Probate Judge Rev.3/2/98 - 3 -