Petition for Kinship Adoption

Petition for Kinship Adoption

IN THE COURT OF (County), (State)

IN THE MATTER OF THE PETITION OF:

Cause No.

FOR THE ADOPTION OF A CHILD

Petition for Kinship Adoption

The Petitioner , being desirous of adopting a child so as to make said child for all intents and purposes the legal child of Petitioner and to render him capable of inheriting Petitioner’s estate, states the following facts:

1. The Petitioner is the child’s:

Aunt

Uncle

Sister

Brother

Half-Sibling

First Cousin

Grandparent

2. Information about the Petitioner:

Petitioner’s Full Name

Place of Birth:

Race:

Date of Birth:

Current Mailing Address:

City & Zip Code:

Cell #: Work Phone #: Home Phone #:

Occupation:

Length of Residence in :

Place of residence at the time of birth of the child:

3. Date of Marriage: . As shown by her signature hereon, Petitioner’s wife , has, and does hereby, join in this Petition.

4. Venue is proper in this matter because the Petitioner resides in the County of .

5. On , the Petitioner consulted with the appropriate local County Department of Social Services concerning the possible eligibility of the Petitioner and the child for temporary assistance for needy families (TANF), Medicaid, subsidized adoption and other services or public assistance administered by the County Department of Social Services.

6. The Petitioner has attached as Exhibit A a current fingerprint-based criminal history records check as required by .

7. The Petitioner has attached as Exhibit B the background check as required by .

8. Petitioner has never been convicted of a felony or misdemeanor in any of the following areas, with the exception of the felony or misdemeanor checked and identified as follows:

Child abuse or neglect on Felony Misdemeanor

Spousal abuse on Felony Misdemeanor

Any crime against a child on Felony Misdemeanor

Any crime, the underlying factual basis of which has been found by the Court to include an act of domestic violence on Felony Misdemeanor

Violation of a Protection/Restraining Order on Felony Misdemeanor

Any crime involving violence, rape, sexual assault, or homicide on Felony Misdemeanor

Any felony involving physical assault or battery on Felony Misdemeanor

Any felony drug-related conviction within the past five years, at a minimum on Felony Misdemeanor

9. Identify all children of the Petitioner(s) (both natural and adopted and both living and deceased).

Full Name of Child:

Full Name of Child:

Full Name of Child:

Full Name of Child:

Full Name of Child:

10. Facts concerning the child to be adopted (excluding facts if placement is by an agency or Department of Social Services.)

A. Date of Birth: Full Name:

B. Relationship of child to Petitioner, if any:

C. Place of Birth:

D. Place of Residence:

11. The child is is not a member or eligible to be a member of an Indian tribe as defined by the Indian Welfare Act. If applicable, the name of the tribe is: and notice of this Petition has been provided to the parent or Indian custodian of the child and to the tribal agent of the tribe, as required by (cite statute).

12. Reasonable efforts have been made to send notice to the identified persons as follows:

13. The child has been in the care and custody of Petitioner since (date).

14. The legal custody of the child is with (Name).

15. A full description of the property of the child, if any is as follows:

16. The name and address of the Guardian(s) of the child and estate of the child, if any, that have been appointed is/are:

17. A certified copy of the Court orders granting legal guardianship or allocation of parental responsibilities (decision-making and parenting time) is attached hereto and incorporated herein by reference.

18. Information about the Birth Parents of the Child:

A. Full name of birth father: , who resides at

B. Full name of birth mother , who resides at

19. The written consent(s) of the parent(s) is/are attached, or is/are not attached.

20. The child will not be the subject of a pending dependency and neglect action when the adoption is heard.

21. If parental rights are relinquished, are terminated, or are being terminated in this action pursuant to (cite state statutes), or parent is deceased, state details:

22. Wherefore, the Petitioner prays that a Decree of Adoption be entered herein declaring said child to be the child of Petitioner and that the name of said child be changed to: (state full name) and that said child shall be entitled to all of the rights and privileges and be subject to all of the obligations now conferred and imposed by law.

Verification and Acknowledgement

I swear/affirm under oath that I have read the foregoing Petition and that the statements set forth herein are true and correct to the best of my knowledge.

STATE OF

COUNTY OF

Personally appeared before me, the undersigned authority in and for the aforesaid jurisdiction, the within named and who, after having been first duly sworn, stated on oath that the matters and facts set forth in the above and foregoing Petition are true and correct as therein stated.

SWORN to and subscribed before me, this the (date).

My Commission Expires: