Free ADOPT-200.111306.mc.ofm - California

COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : ADOPT-200 Adoption Request

Clerk stamps date here when form is filed.

Index No. Calendar No.

If you are adopting more than one child, fill out an adoption request for each child.
1 Your name (adopting parent): a. -againstb. Relationship to child: Street address: City: State:
Plaintiff(s)

: : : :

JUDICIAL SUBPOENA

: Zip: Defendant(s) : Telephone number: ( ) ...................................................... Lawyer (if any): (Name, address, telephone numbers, and State Bar number): THE PEOPLE OF THE STATE OF NEW YORK

Fill in court name and street address:

Superior Court of California, County of

2

TO Type of adoption (check one):

Fill in case number if known:

Case Number:

Agency (name): Joinder has been filed. GREETINGS: be filed. Joinder will Independent WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before International , the Honorable (name of agency): at the Court Stepparent located at County of inRelative room , on the day of , 20 , at o'clock in the noon, and at any recessed 3
or adjourned date, to testify Information about the child: and give evidence as a witness in this action on the part of the a. The child's new name will be: e. Place of birth (if known): City: b. BoyYour Girl to comply with this subpoena is punishable as a contempt of court and will make you liable to failure Country: State: a If the child is 12 of $50 does the child agree to c.the party birth: Date of on whose behalf this subpoena was issued for f. maximum penaltyor older,and all damages sustained as a Age: d.result of your failuredifferent from yours): Child's address (if to comply. Yes No the adoption? Street: g. Date child was placed in your physical care: State: , one of the Justices of the City: Witness, Honorable Zip: Court in County, day of , 20 Child's name before adoption: (Fill out ONLY if this (To be completed by the clerk of the superior court is an independent, relative, or stepparent adoption.)
if a hearing date is available.)
(Attorney must sign above and type name below)

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Does the child have a legal guardian? Yes No If yes, attach a copy of the Letters of Guardianship and fill out below: a. Date guardianship ordered: b. County: c. Case number: Is the child a dependent of the court? If yes, fill out below: Juvenile case number: County: Yes No

Hearing is set for: Date: Time: Attorney(s) for Dept.: Room: Name and address of court if different from above: Hearing Date

6

Office and P.O. Address To the person served with this request: If you do not come to this hearing, the judge can order the adoption without your input.

Judicial Council of California, www.courtinfo.ca.gov Revised January 1, 2007, Mandatory Form Family Code, §§ 8714, 8714.5, 8802, 8912, 9000; Welfare & Institutions Code, § 16119; Cal. Rules of Court, rule 5.730

Telephone No.: Facsimile No.: E-Mail Address: Adoption Request Mobile Tel. No.:

ADOPT-200, Page 1 of 3
American LegalNet, Inc. www.FormsWorkflow.com

Case Number:

Your name:
7 Yes No Child may have Indian ancestry: If yes, attach Form ADOPT-220, Adoption of Possible Indian Child. Names of birth parents, if known: a. Mother: b. Father: If this is an agency adoption a. I have received information about the Adoption Assistance Program Regional Center and about No Yes mental health services available through Medi-Cal or other programs. b. All persons with parental rights agree that the child should be placed for adoption by the California Department of Social Services or a licensed adoption agency (Fam. Code, § 8700) and have signed a relinquishment form Yes No (if no, list the name and approved by the California Department of Social Services. relationship to child of each person who has not signed the consent form):

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10 If this is an independent adoption a. A copy of the Independent Adoptive Placement Agreement, a California Department of Social Services form, is attached. (This is required in most independent adoptions; see Fam. Code, § 8802.) b. All persons with parental rights agree to the adoption and have signed the Independent Adoptive Placement Agreement, a California Department of Social Services form. Yes No (if no, list the name and relationship to child of each person who has not signed the consent form): c. I will file promptly with the department or delegated county adoption agency the information required by the department in the investigation of the proposed adoption. 11 If this is a stepparent adoption a. The birth parent (name):

has signed a consent

will sign a consent

has signed a consent will sign a consent b. The birth parent (name): c. The adopting parents were married on or The domestic partnership was registered on . (For court use only. This does not affect social worker's recommendation. There (date): is no waiting period.) 12 There is no presumed or biological father because the child was conceived by artificial insemination, using semen provided to a medical doctor or a sperm bank. (Fam. Code, § 7613.)

13 Contact after adoption is attached will not be used Form ADOPT-310, Contact After Adoption Agreement, is undecided at this time will be filed at least 30 days before the adoption hearing 14 The consent of the § 8606 subdivision): birth mother presumed father is not necessary because (specify Fam. Code,

Revised January 1, 2007

Adoption Request

ADOPT-200, Page 2 of 3

Case Number:

Your name:
15 A court ended the parental rights of (attach copy of order): Name: Relationship to child: Relationship to child: Name:

on (date) on (date)

16

I will ask the court to end the parental rights of (attach copy of Petition to Terminate Parental Rights or Freedom From Parental Custody, if filed): Name: Relationship to child: Relationship to child: Name: Each of the following persons with parental rights has not contacted his or her child in one year or more. (Fam. Code, § 8604(b)) (Attach copy of Application for Freedom From Parental Custody, if filed.) Name: Name: Relationship to child: Relationship to child:

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18

Each of the following persons with parental rights has died: Name: Name: Relationship to child: Relationship to child:

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Suitability for adoption Each adopting parent: a. Is at least 10 years older than the child b. Will treat the child as his or her own c. Will support and care for the child d. Has a suitable home for the child and e. Agrees to adopt the child

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I ask the court to approve the adoption and to declare that the adopting parents and the child have the legal relationship of parent and child, with all the rights and duties of this relationship, including the right of inheritance. If a lawyer is representing you in this case, he or she must sign here:

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Date:
Type or print your name Signature of attorney for adopting parents

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I declare under penalty of perjury under the laws of the State of California that the information in this form is true and correct to my knowledge. This means that if I lie on this form, I am guilty of a crime.

Date:
Type or print your name Signature of adopting parent

Date:
Type or print your name Signature of adopting parent

Revised January 1, 2007

Adoption Request

ADOPT-200, Page 3 of 3