Free ADOPT-230.v6.092606.mc.ofm - California


File Size: 27.2 kB
Pages: 2
Date: June 24, 2009
File Format: PDF
State: California
Category: Court Forms - State
Author: mcaamic
Word Count: 350 Words, 2,113 Characters
Page Size: Letter (8 1/2" x 11")
URL

http://www.courtinfo.ca.gov/forms/documents/adopt230.pdf

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ADOPT-230

Clerk stamps date here when form is filed.

Adoption Expenses

If you are adopting your stepchild, do not fill out this form. 1 Your name (adopting parent): a. b. Relationship to child: Address (skip this if you have a lawyer): Street: State: Zip: City: ) Telephone number: ( Lawyer (if any): (Name, address, telephone number, and State Bar number):

Fill in court name and street address:

Superior Court of California, County of

Fill in case number if known:

Case Number:

2

Name of child after adoption:

3

List the services you received that were related to the adoption of the child listed in 2 :

Service
a. Hospital

Name and address of service provider

How much paid, or value of service
$

Payment date

b. Prenatal care

$

c. Legal fees paid

$

d. Adoption agency fee paid e. Transportation

$

$

f. Adoption facilitator fees paid

$

Judicial Council of California, www.courtinfo.ca.gov Revised January 1, 2007, Mandatory Form Family Code, 8610

Adoption Expenses

ADOPT-230, Page 1 of 2
American LegalNet, Inc. www.FormsWorkflow.com

Case Number:

Your name: How much paid, or value of service
$

Service
g. Counseling fees paid

Name and address of service provider

Payment date

h. Adoption service provider i. Pregnancy expenses paid j. Court filing fees paid

$

$

$

k. Fingerprinting fees paid l. Other

$

$

If you need more space, attach a sheet of paper and write "ADOPT-230, Item 3--Payment for Services" at the top. Number of pages attached: 4 I declare under penalty of perjury under the laws of the State of California that I have listed all payments (or anything of value) that I have paid or agreed to pay, or that were paid on my behalf, related to the child I want to adopt. I declare under penalty of perjury under the laws of the State of California that the information in this form is true and correct, which 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 Expenses

ADOPT-230, Page 2 of 2