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Adoption Agreement between Adult and Adopting Parent Agreement made on the _____________ (date), between__________________ (Name of Adoptive Parent) of _____________________________________________ _____________________________ (street address, city, state, zip code), referred to herein as Adoptive Parent, and _____________________ (Name of Adoptee), of ______________________________________________________________________ (street address, city, state, zip code), referred to herein as Adoptee. Whereas, Adopting Parent, _____ (number) years of age, desires to adopt Adoptee; and Whereas, Adoptee, _____ (number) years of age, desires to be adopted by Adopting Parent; and Whereas, the parties desire to assume toward each other the legal relationship of parent and child, and to have all the rights and be subject to all of the duties and responsibilities of that relationship; and Whereas, Adopting Parent intends to present to _________________ (name of court) of _________________________ (name of county and state), a Petition in which he will seek a decree approving the adoption of Adoptee; Now, therefore, for and in consideration of the mutual covenants contained in this agreement, and other good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, the parties agree as follows: 1, The parties agree to assume toward each other the legal relation of parent and child. Adopting Parent will henceforth treat adoptee as if he were the natural child of adopting parent. Adoptee will henceforth treat adopting parent as his natural parent. Both parties will have all the rights and be subject to all the duties and responsibilities of the relation of parent and child. 2. The parties will file a Petition for Adoption in _________________ (name of court) of _____________________________ (name of county and state), requesting that the court approve this Agreement and enter a decree that Adoptee is the child of Adopting Parent, and that Adoptee bear the name of Adopting Parent. WITNESS our signatures as of the day and date first above stated. ______________
Adopted born page 5 hall of fame county of hartford district no. 4 wigg. Jas. Schaffner county of lynn fitch kilgore county of new lexington douglas county of west new york cowell county of western new york (signature of witness) (the clerk certified this document as an exhibit to the court). The judges: judge: c. G. Jeffrey judge: c. G. Jeffrey witness: signed and sealed after the record is closed by judgment (signed by judges joseph m. Gribbs and edward c. Ries), date: january 24, 1989. (this certificate reads as follows:) witness: adopting pupil and adopting adult judge: g. Katherin judge: david f. Woodward judge: michelle c. Hindez judge: michelle c. Hindez witness: adopted pupil and adopted adult the judges: judge judge judge judge: m. C. Hindez judge: m. C. Hindez judge: m. C. Hindez judge: m. C. Hindez county of new york douglas hartford douglas counties school division of new york county kilgore c