Fill and Sign the Probate Court Form 139f

Page -1- Probate Court Form 139F Adoption Decree Stepparent Adoption of a Minor (Page 1 of 3) STATE OF VERMONT PROBATE COURT DISTRICT OF _______________________ IN RE ADOPTION OF _________________ DOCKET NO. ______________ ADOPTION DECREE - STEPPARENT ADOPTION OF A MINOR 15A V. S. A. 4-101 et seq. 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 the minor was filed by ______________________________ on _________________________,20_____. 3. The minor was born on _______________, 20____ at _____________________. The time of birth was _________________ (A.M./P.M.). 4. The petitioner _____ is _____ is not married. 5. The petitioner is a stepparent of the adoptee or is a person who is treated as a stepparent of the adoptee pursuant to 4- 101(b) of the Adoption Act. 6. Check one: ______ A new birth certificate sha ll not be issued because either the petitioner, or the minor, who is over the age of 14, has re quested 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: Father: Name: __________________________________ Date of Birth: _____________________________ Place of Bi rth: ____________________________ Mother: Maid en Name: ___________________________ Name by Which Mother is Known: __________________ _______________________________________________ Date of Birth : ___________________________________ Place of Bi rth: ___________________________________ 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. Page -2- Probate Court Form 139F Adoption Decree Stepparent Adoption of a Minor (Page 2 of 3) 9. Notice of this proceeding for adoption has been served or dispensed with as to those persons entitled to receive notice under Part 3 of Article 3 of the Adoption Act and 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 4-110 of the Adoption Act. 12. The court has obtained the information required by 203-(d)(7)-(9) of the Adoption Act. 13. Each item required by 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 inter- country placement for this adoption have been met. 15. The Indian Child Welfare Act 25 U. S. C. 1901 et seq., is not applicable to this proceeding, or, if applicable, its requirements have been met. 16. The accounting and affidavit required by 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 with respect to this adoption. 17. The petitioner has received each report required by 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 set forth in 1-104 of the Adoption Act; B. The decree shall not affect: 1. The legal relationship between the parent who is the adoptive stepparent’s spouse or deceased spouse and the adoptee shall remain the same as it was prior to the adoption. 2. 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 stepparents’s spouse or deceased spouse; or Page -3- Probate Court Form 139F Adoption Decree Stepparent Adoption of a Minor (Page 3 of 3) 3. A court order of agreement for visita tion or communication with a minor adoptee approved by the court pursuant to 4-112 of the Adoption Act. C. The legal relationship between the parent who is not the spouse or the deceased spouse of the stepparent and the adoptee shall be as set forth in 1-105 of the Adoption Act, EXCEPT THAT: 1. The minor and any descendant of the minor will retain rights of inheritance from and through this parent; and 2. A court order for visitation or communica tion with the minor by this parent or by a person related to the minor through this parent, or an agreement or order concerning another person who is appr oved by the court pursuant to 4-112 of the Adoption Act survives the decree of adoption, but failure to comply with the terms of the order or agreement is not a ground for revoking or setting aside the adoption. 3. This parent remains liable for arrearage of child support unless released from that obligation by the other parent, and any guardian al litem of the minor and any governmental entity providing public assistance to the minor. THEREFORE, it is hereby ORDERE D AND DECREED that the minor, ______________ __________________________________, is adopted by, and made the child of, _______________________________________ and shall he reafter bear the name of _______________________________________. Dated: _________________________________ _______________________________________ Probate Judge Probate Court, District of _______________________