Fill and Sign the Petition for Adoptive Placement Wisconsin Form

For Official Use STATE OF WISCONSIN, CIRCUIT COURT,       COUNTY IN THE MATTER OF THE ADOPTIVE PLACEMENT OF       a person under the age of 18. Petition for Adoptive Placement       Date of Birth Case No.       Under oath, I state that: 1a. The child was born on the date indicated above and resides at:       1b. The child is due to be born about       2. The birth mother       , age       , resides at       3. The birth father       , age       , resides at       4. The proposed adoptive mother       , age       , resides at       5. The proposed adoptive father       , age       , resides at       6. (Person/agency)       arranged placement of the child. 7. The report of financial, medical and legal arrangements is attached. 8. The placement is in a licensed foster home. 9. The Petition for Termination of Parental Rights accompanies this petition. Subscribed and sworn to before me on       Notary Public, State of Wisconsin My commission expires:       Signature of Petitioner       Name Printed or Typed Signature of Petitioner       Name Printed or Typed       Date JC-1640, 11/99 Petition for Adoptive Placement §48.837, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material.