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Adoption Request

COURT

ADOPT-200 Adoption Request
.
COUNTY OF
Clerk stamps below when form is filed.
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
If you are adopting more than one child, fill out an
adoption request for each child.
Your name(s) (adopting parent(s)):
a.
b.
Relationship to child:
Your address:
Street:
-against-
Plaintiff(s)

Defendant(s)
City: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Zip: . . . . . . . . . . . . State:. . . . .
Your phone #:( )
Your lawyer (if you have one): (Name, address, phone #,
THE PEOPLE OF THE STATE OF NEW YORK
and State Bar #):

TO

Type of adoption: (Check one)
GREETINGS:
Agency (name):
Relative
Independent
:

:

:

:

:

:

:
Index No.

Calendar No.

JUDICIAL SUBPOENA

Court name and street address:
Superior Court of California, County of

Case Number:
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before the Honorable at the Court
International (name of agency):

in room , on the day of , 20 , at o'clock in the
or adjourned date, to testify and give evidence as a witness in this action on the part of the
Information about the child:
County of
located at
Stepparent/Domestic Partner
noon, and at any recessed
a. The child's new name will be:
e. Place of birth (if known):
City:
,

the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply.
c. Date of birth:
Age:
f. If the child is 12 or older, does the child agree to the adoption? Yes No
City:
, 20
, one of theState:
Justices of theZip:
d. Child's address (if different from yours):
Street:
Witness, Honorable
County, day of
Child's name before adoption (Fill out ONLY if this is an independent, relative, or stepparent/domestic partner adoption.):
Court in
Does the child have a legal guardian?
Yes
b.
Boy
Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to
Girl
State:
Country:

(To be completed by the clerk of the superior court if a hearing date is available.)
(Attorney must sign above and type name below)
Hearing is set for:

Attorney(s) for

Date:
Dept.:
Time:
Room:
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
Name and address of court if different from above:

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.
Telephone No.:
Facsimile No.:
E-Mail Address:
Judicial Council of California, www.courtinfo.ca.gov
Rev. January 1, 2004, Mandatory Form
Family Code, §§ 8714, 8714.5, 8802, 8912, 9000; Welfare &
Institutions Code, § 16119; Cal. Rules of Court, rule 1464

Adoption Request
Mobile Tel. No.:
ADOPT-200, Page 1 of 3

American LegalNet, Inc.
www.USCourtForms.com
Case Number:
Your name(s):

Child may have Indian ancestry:
Yes
No
If yes, attach Form ADOPT-220, Adoption of Indian Child.

If this is an Agency Adoption:
a. I/We have received information about the Adoption Assistance Program, Regional Center,
and mental health services available through Medi-Cal or other programs. Yes No
b. All persons with parental rights agree 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 approved by the California Department of
Social Services except:
Name:
Name:

If this is an Independent Adoption:
Relationship to child:
Relationship to child:


a. A copy of the Adoptive Placement Agreement is attached. (Required in most independent
adoptions; see Fam. Code, § 8802.)
b. I/We will file promptly with the department or delegated county adoption agency
information required by the department in the investigation of the proposed
adoption. Yes No
c. All persons with parental rights agree to the adoption and have signed the Adoptive
Placement Agreement Consent to Adoption on a form approved by the California
Department of Social Services except:
Name:

Name:
Relationship to child:

Relationship to child:

If this is a Stepparent/Domestic Partner Adoption:
a. The birth parent is in state out of state
(If out of state and unable to sign in the presence of the required official, the parent may
sign his or her consent before a notary. (Fam. Code, § 9003 (b).))
(date) OR Domestic partnership registered: (date).
(This does not affect the social worker's recommendation. Information is for court only.
There is no waiting period.)


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.)

Form ADOPT-310, Contact After Adoption Agreement:
Is attached Will not be used Will be filed at least 30 days before the adoption hearing
b. Adopting parents married:
Undecided at this time
Name of birth parents if you know:
a.
b.
The consent of the
§ 8606 subdivision):
birth mother


(mother)
(father)

presumed father is not necessary because (specify Fam. Code,
Rev. January 1, 2004
Adoption Request
ADOPT-200, Page 2 of 3
Case Number:
Your name(s):


A court ended the parental rights of:
Name:
Name:
Relationship to child:
Relationship to child:


I/We will ask the court to end the parental rights of:
Name:
Name:
Relationship to child:
Relationship to child:


Each of the following persons with parental rights has not contacted his or her child in one
year (Fam. Code, § 8604(b)):
Name:
Name:
Relationship to child:
Relationship to child:


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

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
Relationship to child:
Relationship to child:

d. Has a suitable home for the child and
e. Agrees to adopt the child.


I/We ask the court to approve the adoption and to declare that the adopting parent(s) 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:
Date:
Type or print your name
Signature of Attorney for Adopting Parent


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 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
Print This Form

Rev. January 1, 2004

Adoption Request
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ADOPT-200, Page 3 of 3

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