COURT COUNTY OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .:::::::Index No.ADOPTION CHECKLISTCalendar No.JUDICIAL SUBPOENAPlaintiff(s) -against-Defendant(s)Petitioner:; Adoption Case No.Child:Comments: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .THE PEOPLE OF THE STATE OF NEW YORK TOJurisdiction (D.C. Code Ann. § 16-301(b) (2001) (check at least one) 1.Petitioner was a legal resident of D.C. when petition filed OR Petitioner was an actual resident of D.C. for at least one year immediately preceding filing2.Child is in the legal custody of CFSA or child-placing agency licensed in DC. Agency: GREETINGS:WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Court at the the Honorable,Petitioner Eligibility (D.C. Code Ann. § 16-302 (2001)) (check at least one) 1.located at County ofo'clock in the day of, on the, 20, at or adjourned date, to testify and give evidence as a witness in this action on the part of thenoon, and at any recessed in roomis not married2.is married and spouse is a party in this matterYour failure to comply with this subpoena is punishable as a contempt of court and will make you liable to 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., one of the Justices of theDiscretionary Waiver of Investigative Report (D.C. Code Ann. § 16-308 (2001)) No report is required because 1.Adoptee is an adult (18 or older)Court in Witness, Honorableday of, 20 County,2.Petitioner is the spouse of a natural parent who consents or is also a Petitioner(Attorney must sign above and type name below)Attorney(s) forPetitioner's allegations are true or inaccuracies are explained.Investigative Report (D.C. Code Ann. § 16-307 (2001) and Super. Ct. Adoption R. 7(d)) (This is only a partial listing of requirements. NOTE: The court may enter a decree after consideration of a report from which some information is missing.) Report contains the following representations (all must be checked) 1.Office and P.O. Address2.Prospective adoptee is a proper subject for adoption after investigation of adoptee's environment, antecedents, and assets (assets over $3000 to be itemized).Telephone No.: Facsimile No.: E-Mail Address:3.Prospective home is suitable.1Mobile Tel. No.:American LegalNet, Inc. www.USCourtForms.comCOURT COUNTY OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .:::::::Index No.4.Suitable subsidy agreement (if any) approved.Calendar No.5.Child residing with Petitioner(s) since (at least 6 months ago).JUDICIAL SUBPOENAPlaintiff(s) -against-Defendant(s)6.Three post-placement interviews completed (29 D.C.M.R. 1624.2)Dates: 1. 2. 3. 7.Documentation of the agency's contacts with three (3) references (29 D.C.M.R. 1620.5(u)8.Agency recommends issuing adoption decree. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .FinalInterlocutoryTHE PEOPLE OF THE STATE OF NEW YORK TO9. Signature of social worker and social worker supervisor and statement that report is true and correct 10. CFSA Director ApprovalClearances (D.C. Code Ann. § 4-1305.01 et seq. and 29 D.C.M.R. 16205(q),(r))GREETINGS:WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Court at the the HonorableP 1P2OTHER (Date),(Date)(Date)located at County ofo'clock in the day of, on the, 20, at or adjourned date, to testify and give evidence as a witness in this action on the part of thenoon, and at any recessed in roomYour failure to comply with this subpoena is punishable as a contempt of court and will make you liable to 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., one of the Justices of theCourt in Witness, Honorableday of, 20 County,1. Child Prection Register check within one year for all adults in household and from all states where the adults have lived in the last then years 2. Criminal history check within one year (everywhere but Maryland) for all adults in household 3. FBI clearance within two years (everywhere but Maryland) for all adults in household 4. Medical clearance within one year for every household member 5. Military registry check, if applicable(Attorney must sign above and type name below)Attorney(s) forOffice and P.O. AddressTelephone No.: Facsimile No.: E-Mail Address:Mobile Tel. No.:2American LegalNet, Inc. www.USCourtForms.comCOURT COUNTY OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .:::::::Index No.Calendar No.JUDICIAL SUBPOENAPlaintiff(s) -against-Defendant(s)Interstate Compact on Placement of Children Compliance (ICPC) (D.C. Code Ann. §§ 4-1421 to 4-1424 (2001 & Supp. 2003)) 1.Petitioner proposes sending child fromtofor purpose of adoption AND child was placed after September 20, 1989, AND Agency has provided a notice of compliance with the ICPC2.No compliance is required because (check one or both)a.Petitioner does not propose sending child from one jurisdiction to another jurisdiction for purpose of adoption AND/OR. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .b.Child was placed on/before September 20, 1989THE PEOPLE OF THE STATE OF NEW YORK TOConsents for Adoptees Under Age 18 (D.C. Code Ann. § 16-304) A.Signed and acknowledged consent of adoptee 14+ yrs (b)(1)BMBFGREETINGS:B.Consent issue resolved (one category below must be checked for each parent)WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Court at the the Honorable,located at County of1.Signed and acknowledged consent (b)(2)o'clock in the day of, on the, 20, at or adjourned date, to testify and give evidence as a witness in this action on the part of thenoon, and at any recessed in room2.Relinquishment of rights per D.C. Code Ann. § 4-14063.Parental rights terminated (OR "released") (b)(2)(D) AND Consent of CFSA or the Agency (b)(2)(E)Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages su
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