Free AD01 - California

ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, state bar number and address):

TELEPHONE NO: E-MAIL ADDRESS (OPTIONAL) ATTORNEY FOR:

FAX NO: (OPTIONAL)

San Luis Obispo Branch 1035 Palm Street, Room 385, San Luis Obispo, CA 93408-2500 web site: www.slocourts.net
In the matter of the Adoption Petition of:

SUPERIOR COURT OF SAN LUIS OBISPO COUNTY

FINANCIAL STATEMENT (STEPPARENT ADOPTION)

CASE NO:

We, the undersigned declare that our gross family income as substantiated by our most recent Federal Tax Return, filed in 20____, falls into the category checked below: $19,000 and below $19,001-$34,999 $35,000-$49,999 $50,000 and above

We declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Dated: ___________________________ ________________________________________ Petitioner ________________________________________ Parent Retaining Custody

AD01 Rev. May 2003 Mandatory

(STEPPARENT

FINANCIAL STATEMENT ADOPTION)

FC9002