Fill and Sign the Vermont Adoption Form

STATE OF VERMONT PROBATE COURT DISTRICT OF ____________ In Re the Estate of: ) DOCKET No. __________ ) __________________ ) , Deceased ) ) ) LATE OF ) ) __________________ . ) ) ) 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 name 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 said minor was filed by ____________________ on ____________________ , 20       . 3. The said minor was born on __________ , 20       at ____________________ . The time of birth was ____________________ a.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 § 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. - 1 - 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 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 parents entitled to receive notice under Part 4 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 § 2-203(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 - 2 - filed with the court or, if any of the said items is unavailable, the person responsible for furnishing it has filed affidavit explaining its absence. 14. All applicable requirements of The Adoption Act governing an interstate or intercountry placement for this adoption have been met. 15. The Indian Child Welfare Act, 25 U.S.C. § 1901 et seq., it is not applicable to this proceeding, or, if applicable, 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 or any payment or disbursement which is not authorized under Article 7 of The Adoption Act or the court has waived the requirements of § 3-702 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 as 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 stepparent's spouse or deceased spouse; or 3. A court order or agreement for visitation or communication with a minor adoptee approved by the court pursuant to § 4-112 of The Adoption Act. - 3 - 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 communication 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 which is approved 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 reliable for arrearages of child support unless released from that obligation by the other parent, and any guardian ad litem of the minor and any governmental entity providing public assistance to the minor. 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 this _________ day of _______________, 20_____. ___________________________________________________________ (signature) Probate Judge Rev.3/1/97 - 4 -