Free Petition for Adoption - Massachusetts

Commonwealth of Massachusetts The Trial Court Probate and Family Court Department
Division Docket No.

Petition for Adoption of

(name of child)

M.G.L. c. 210, § 6
To the Justices of the Probate and Family Court: RESPECTFULLY represents PETITIONER (1)

If Petitioner (1) is married, his/her spouse must join in the petition:

(PRINT name of petitioner) (PRINT name of spouse)

(street address)

(city or town/state/zip code)

(telephone number)

that they are (he/she is) desirous of adopting the following child: 1.
(child's name)

Date of Birth:

Place of Birth:

2.
(name of mother) (street address) (name of father) (street address)

(city or town/state/zip code)

(city or town/state/zip code)

3.

that the petitioner(s) is (are) of sufficient ability to rear the child, and to provide suitable support and education for the child; and, that: the child has resided for at least six months in the home of the petitioner(s). the child was the subject of a proceeding pursuant to M.G.L. c. 210, § 3 wherein the Court dispensed with the need for consent of or notice to the parent(s) on a petition for adoption. the child was the subject of a surrender which was executed pursuant to M.G.L. c. 210, § 2. At the time of her surrender the mother was years old. At the time of his surrender the father (legal) was years old.
(OVER)

4.

Petition for Adoption CJ-P 87

c.g.f.

WHEREFORE they (he/she) pray(s): for leave to adopt said child; that the court waive the residence requirement for good cause: (explain)

that said child's name be changed to that of Date SIGNATURE OF PETITIONER 1 SIGNATURE OF PETITIONER 2 This petition is sponsored, recommended and approved by
(name and address of agency)

a charitable corporation organized under the laws of the Commonwealth of Massachusetts for the purpose of engaging in the care of children and principally so engaged.

*
I,

*
(PRINT name of child)

*

*

*

*

, being above the age of twelve years, hereby

consent to this adoption as above prayed.
(signature of child)

WITNESS _______________________________________

WITNESS _______________________________________

NOTARIZATION The above signed _______________________________________ made oath before me on _____________________that
(name of child) (date)

this consent is his/her free act and deed. Signature of Notary Public Print Name

*
For Petitioner(s):

*

*

*

*
PETITION - DECREE

*

(name)

Filed______________________________20_____
(firm name/street address)

Citation issued______________________20_____ Returnable _________________________20_____ Allowed ____________________________20_____

(city/town/state/zip code)

Te. No. B.B.O. #

(

)

Instructions 1. 2. 3. 4. Refer to M.G.L. c. 210, et seq. A certified copy of the child's Birth Record (certificate) must be furnished. The corresponding affidavit forms must accompany the filing of this petition. Certification from the Department of Social Services that the child is not registered with the federal register for missing children must be filed. If the petition is presented, sponsored, or recommended by a charitable corporation organized under the general or special laws of the commonwealth for the purpose of engaging in the care of children and is principally so engaged, then no such certification is required.

c.g.f.