Free STEP PARENT PETITION.PDF - Minnesota

DISTRICT COURT, COUNTY OF _________________________________, STATE OF MINNESOTA In the Matter of the Welfare of __________________________________________, a Child, and the Petition Of _____________________________ and ____________________________, his Wife, to Adopt said Child.

PETITION FOR ADOPTION
Your petitioners respectfully represent and show to the court: 1. That they are husband and wife and were married on _______________________________________ at _______________________________, that their full names are _________________________________ and _____________________________; that their respective ages are _________ and ________ years; that their place of residence is ___________________________________________________ in the County of ____________________________, State of Minnesota; that they have resided in the State of Minnesota for more than one year immediately preceding the filing of this petition; that they are related to the child to be adopted as ________________________________________ which is a relationship by blood or marriage within the third degree***; 2. That they acquired physical custody of __________________________________________________ from ______________________________________ on _____________________________ and that said child has lived in their home since said date. 3. That said child was born in the _________________________ of __________________________ County of ________________________, State of ___________________________ on _____________________. 4. That the mother of said child is ___________________________________________ and that the father is ___________________________; that the guardian of said child is _______________________________. 5. That the actual name of the child and any known aliases are _____________________________________ _____________________________________________________________________________________. 6. That your petitioners desire to have the name of the child changed to ______________________________ _____________________________________________________________________________________. 7. That the description and value of any real or personal property owned by said child are as follows:

8. That your petitioners desire that the relationship of parents and child be established between petitioners and the child, and that it is to the best interest of the child for the child to be adopted by them. 9. That the parent(s) (guardian)(agency)(Commissioner of Human Services) have consented to the adoption as hereinafter shown; or that no consent is required because _______________________________________.

WHEREFORE, your petitioners pray this honorable Court for leave to adopt as their own child, the said _____________________________________________________ in accordance with the statute in such case made and provided, and that the name of said child be changed to __________________________________ _________________________________________ and that such other orders may be made as law and justice may require. ____________________________________ Attorney for Petitioners Address______________________________ _____________________________________ _____________________________________ Petitioner _____________________________________ Petitioner

STATE OF MINNESOTA COUNTY OF ____________________ _______________________________________________ and ____________________________________, his wife, being first duly sworn, on oath say that they have read the within and foregoing petition subscribed by them, and know the contents thereof and that the same is true to their best information and belief. ____________________________________ Petitioner ____________________________________ Petitioner Subscribed and sworn to before me this ________ day of ___________________________, _______.

____________________________________ Notary Public ___________ County, State of Minnesota My Commission Expires ________________

***NOTE: Parent, stepparent, brother, sister, aunt, uncle, grandparent, grandchild, niece, nephew, great grandparent, great grandchild, are within the third degree.

DISTRICT COURT, COUNTY OF _________________________________, STATE OF MINNESOTA

CONSENT OF MOTHER TO ADOPTION AND WAIVER OF NOTICE OF HEARING
The undersigned, being the mother of the child mentioned in the foregoing petition, after being fully advised of all the premises herein, and with a view to the future welfare of the child, hereby consents to the adoption of the said ___________________________________ by _______________________________ and __________________________________ , his wife, petitioners herein, and hereby waives notice of hearing upon the foregoing petition. A parent's consent to the adoption may be withdrawn for any reason within 10 working days after the consent is executed and acknowledged by written notification to the Commissioner of Human Services or his agent, thereafter consent shall be irrevocable, M.S. 259.24, Subd. 6a. THIS AGENCY WILL SUBMIT YOUR CONSENT TO ADOPTION TO THE COURT. THE CONSENT ITSELF DOES NOT TERMINATE YOUR PARENTAL RIGHTS. PARENTAL RIGHTS TO A CHILD MAY BE TERMINATED ONLY BY AN ADOPTION DECREE OR BY A COURT ORDER TERMINATING PARENTAL RIGHTS. UNLESS THE CHILD IS ADOPTED OR YOUR PARENTAL RIGHTS ARE TERMINATED, YOU MAY BE ASKED TO SUPPORT THE CHILD. In Presence of: ___________________________________ (Witness) ___________________________________ (Witness) ______________________________________

STATE OF MINNESOTA COUNTY OF ____________________ On this ______________ day of _________________________, _______, before me personally appeared ________________________ , to me known to be the person described in, and who executed, the foregoing consent and waiver, and acknowledged that she executed the same as her free act and deed. ____________________________________ Notary Public ___________ County, State of Minnesota My Commission Expires ________________

______________________________________ Commissioner of Human Services, his agent or Representative of Licensed Child-Placing Agency STATE OF MINNESOTA COUNTY OF ____________________

On this ___________ day of ______________________, _____, before me personally appeared __________________________________, to me known to be the Commissioner of Human Services, his agent, or a representative of a Licensed Child-Placing Agency and known to me to be personally present when ________________________________ executed the foregoing consent. ____________________________________ Notary Public ___________ County, State of Minnesota My Commission Expires ________________

DISTRICT COURT, COUNTY OF _________________________________, STATE OF MINNESOTA

CONSENT OF FATHER TO ADOPTION AND WAIVER OF NOTICE OF HEARING
The undersigned, being the father of the child mentioned in the foregoing petition, after being fully advised of all the premises herein, and with a view to the future welfare of the child, hereby consents to the adoption of the said ___________________________________ by _______________________________ and __________________________________ , his wife, petitioners herein, and hereby waives notice of hearing upon the foregoing petition. A parent's consent to the adoption may be withdrawn for any reason within 10 working days after the consent is executed and acknowledged by written notification to the Commissioner of Human Services or his agent, thereafter consent shall be irrevocable, M.S. 259.24, Subd. 6a. THIS AGENCY WILL SUBMIT YOUR CONSENT TO ADOPTION TO THE COURT. THE CONSENT ITSELF DOES NOT TERMINATE YOUR PARENTAL RIGHTS. PARENTAL RIGHTS TO A CHILD MAY BE TERMINATED ONLY BY AN ADOPTION DECREE OR BY A COURT ORDER TERMINATING PARENTAL RIGHTS. UNLESS THE CHILD IS ADOPTED OR YOUR PARENTAL RIGHTS ARE TERMINATED, YOU MAY BE ASKED TO SUPPORT THE CHILD. In Presence of: ___________________________________ (Witness) ___________________________________ (Witness) ______________________________________

STATE OF MINNESOTA COUNTY OF ____________________ On this ______________ day of _________________________, _______, before me personally appeared ________________________ , to me known to be the person described in, and who executed, the foregoing consent and waiver, and acknowledged that he executed the same as his free act and deed. ____________________________________ Notary Public ___________ County, State of Minnesota My Commission Expires ________________

______________________________________ Commissioner of Human Services, his agent or Representative of Licensed Child-Placing Agency STATE OF MINNESOTA COUNTY OF ____________________

On this ___________ day of ______________________, _____, before me personally appeared __________________________________, to me known to be the Commissioner of Human Services, his agent, or a representative of a Licensed Child-Placing Agency and known to me to be personally present when ________________________________ executed the foregoing consent. ____________________________________ Notary Public ___________ County, State of Minnesota My Commission Expires ________________

DISTRICT COURT, COUNTY OF _________________________________, STATE OF MINNESOTA

CONSENT OF GUARDIAN TO ADOPTION AND WAIVER OF NOTICE OF HEARING
The undersigned, being the duly appointed, qualified, and acting guardian of the child mentioned in the foregoing petition, after being fully advised of all the premises herein, and with a view to the future welfare of the child, hereby consents to the adoption of the said ___________________________________ by _______________________________ and __________________________________ , his wife, petitioners herein, and hereby waives notice of hearing upon the foregoing petition. A parent's consent to the adoption may be withdrawn for any reason within 10 working days after the consent is executed and acknowledged by written notification to the Commissioner of Human Services or his agent, thereafter consent shall be irrevocable, M.S. 259.24, Subd. 6a. THIS AGENCY WILL SUBMIT YOUR CONSENT TO ADOPTION TO THE COURT. THE CONSENT ITSELF DOES NOT TERMINATE YOUR PARENTAL RIGHTS. PARENTAL RIGHTS TO A CHILD MAY BE TERMINATED ONLY BY AN ADOPTION DECREE OR BY A COURT ORDER TERMINATING PARENTAL RIGHTS. UNLESS THE CHILD IS ADOPTED OR YOUR PARENTAL RIGHTS ARE TERMINATED, YOU MAY BE ASKED TO SUPPORT THE CHILD. In Presence of: ___________________________________ (Witness) ___________________________________ (Witness) ______________________________________

STATE OF MINNESOTA COUNTY OF ____________________ On this ______________ day of _________________________, _______, before me personally appeared ________________________ , to me known to be the person described in, and who executed, the foregoing consent and waiver, and acknowledged that ___he executed the same as h___ free act and deed. ____________________________________ Notary Public ___________ County, State of Minnesota My Commission Expires ________________

______________________________________ Commissioner of Human Services, his agent or Representative of Licensed Child-Placing Agency STATE OF MINNESOTA COUNTY OF ____________________

On this ___________ day of ______________________, _____, before me personally appeared __________________________________, to me known to be the Commissioner of Human Services, his agent, or a representative of a Licensed Child-Placing Agency and known to me to be personally present when ________________________________ executed the foregoing consent. ____________________________________ Notary Public ___________ County, State of Minnesota My Commission Expires ________________

DISTRICT COURT, COUNTY OF _______________________________, STATE OF MINNESOTA

CONSENT OF CHILD OVER FOURTEEN YEARS OF AGE
The undersigned, being the child mentioned in the foregoing petition, hereby consents that (s)he be adopted by _______________________________ and __________________________________, his wife.

In Presence of: ___________________________________ (Witness) ___________________________________ (Witness) ______________________________________

STATE OF MINNESOTA COUNTY OF ____________________ On this ______________ day of _________________________, _______, before me personally appeared ________________________ , to me known to be the person described in, and who executed the foregoing consent, and acknowledged that ___he executed the same as h___ free act and deed. ____________________________________ Notary Public ___________ County, State of Minnesota My Commission Expires ________________

______________________________________ Commissioner of Human Services, his agent or Representative of Licensed Child-Placing Agency STATE OF MINNESOTA COUNTY OF ____________________

On this ___________ day of ______________________, _____, before me personally appeared __________________________________, to me known to be the Commissioner of Human Services, his agent, or a representative of a Licensed Child-Placing Agency and known to me to be personally present when ________________________________ executed the foregoing consent. ____________________________________ Notary Public ___________ County, State of Minnesota My Commission Expires ________________