STATE OF SOUTH CAROLINA
) ) COUNTY OF ) ) ) Petitioner ) ) vs. ) ) South Carolina Department of Health ) and Environmental Control, ) Respondent. ) In Re: ) )
IN THE FAMILY COURT JUDICIAL CIRCUIT PETITION FOR DOMESTICATION OF FOREIGN ADOPTION FILE NO. § § 20-7-1795(B), 44-63-140
The Petitioners allege: 1. The Petitioners are citizens and residents of the county of , State of South
Carolina, United States of America, with an address of: Street Address: City Zip Code:
The male/female child adopted by the Petitioners, hereinafter referred to as "child," is presently , and was born in the City of . day of the month of , in the year of , and
Country of 3. The child was born on the
, and was not a United States citizen at that time. 4. The Petitioners adopted the child in the City of , located in the Country of
, as shown by the original decree of adoption issued by the foreign country in which the child was born, attached hereto as Exhibit A and incorporated herein by reference. 5. a. The Petitioners were approved to adopt this child by virtue of the foreign country's
permission to adopt that was issued to them by a National Official, as more accurately set forth in Exhibit B attached hereto and incorporated herein by reference.
b. No specific permission to adopt was required, as set forth in the procedures for adoption attached hereto as Exhibit B and incorporated herein by reference. 6. The child was authorized to enter the United States as evidenced by Exhibit C attached hereto
and incorporated herein by reference. 7. Number (Date) a. The child is a United States citizen by virtue of citizenship granted by Certificate with INS Registration Number , which was issued on
. A copy of the certificate, attached hereto as Exhibit D and incorporated herein .
by reference, reflects that the child's name is b. The child is not a United States citizen. 8.
The following documents, attached hereto as Exhibit E and incorporated herein by reference,
were relied upon by the foreign country in the adoption process.
A home study was conducted as evidenced by Exhibit F, attached hereto and incorporated
herein by reference. 10. The Petitioners know of the following property, either real or personal, that the child owns: Description of Property Location of Property
The Petitioners attest that no other Certificate of Foreign Birth has ever been issued for the
child by any other State in the United States of America. SCCA/476B
The Petitioners request that this Court grant the following relief:
(Check one or more) a. An Order recognizing and domesticating the foreign adoption of the child in South Carolina. b. An Order directing the State Registrar to issue a Certificate of Foreign Birth showing Petitioners as the parents of the child. c. A name change for the child from his/her present name of name of . to the new
d. That the records of these proceedings be sealed. e. Other relief described as follows:
WHEREFORE, the Petitioners pray that this Court inquire into the matter set forth herein and that it grant the relief requested in paragraph 12 and such other and further relief as the Court may deem just and proper.
, South Carolina
Petitioners(s)/Attorney for Petitioner(s)