Vermont > Statewide > Probate Court
Adoption Petition 131 - Vermont
| Adoption Petition Form. This is a Vermont form and can be used in Probate Court Statewide . |
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FORM 131. ADOPTION PETITION STATE OF VERMONT PROBATE COURT DISTRICT OF ________________, SS DOCKET NO. ______ IN RE THE ADOPTION OF ____________________________________________________, OF ________________________________________________________________ ADOPTION PETITION 15A V.S.A. 3-304 Part I. The undersigned petitioner(s) represent that: 1. The person to be adopted is: Name: ______________________________________, Place of birth: ______________ Date of birth: __________________________, Time of birth: _____________ _________ Sex: ___________, To be known as: __________________________________________ Child has resided with petitioner(s) since: ______________________________________ Child G is G is not an Indian child as defined by the Indian Child Welfare Act. 2. The petitioner(s) are: Name: ______________________________________, Date of birth: _______________ Mailing address: _________________________________________________________ _________________________________________________________ Town and state of residence: ___________________________, For how long? ________ Occupation: ___________________________________, Approximate income: _______ Current marital status: ______________________, Is divorce pending? ______________ If married, has spouse been judiciallydetermined to be incompetent? _________________ Relationship to adoptee: ______________________________________________________ Date of most recent favorable preplacement evaluation: ___________________________ Date, court and disposition of any previous petition to adopt: _______________________ __________________________________________________________________________ __________________________________________________________________________ Name: ______________________________________, Date of birth: _______________ Mailing address: _________________________________________________________ _________________________________________________________ Town and state of residence: ___________________________, For how long? ________ Occupation: ___________________________________, Approximate income: _______ Current marital status: ______________________, Is divorce pending? ______________ If married, has spouse been judiciallydetermined to be incompetent? __________________ Relationship to adoptee _______________________________________________: _______<<<<<<<<<********>>>>>>>>>>>>> 2Form 131 Page 2 Date of most recent favorable preplacement evaluation: ___________________________ Date, court and disposition of any previous petition to adopt: _______________________ __________________________________________________________________________ __________________________________________________________________________ 3. The petitioners acquired physical custody of the minor on: _________________________ If the child is not in the physical custody of the petitioners, explain the reason and the date and manner in which the petitioners intend to obtain physical custody: __________________________________________________________________________ __________________________________________________________________________ 4. If the child was born out of wedlock, have the parents intermarried?G Yes G No If the childs parents are divorced, custody was awarded to: _________________________ 5. The name and address of the person or agency who placed the child with the petitioners is: _______________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ If not an agency, the relationship of the person who placed the child with the petitioners is: _______________________________________________________________________ 6. The description and approximate value of known property of the minor is: __________________________________________________________________________ __________________________________________________________________________ 7. The petitioner is aware that the following court orders are in effect or pending regarding the child: Child support: _____________________________________________________________ Custody: __________________________________________________________________ Visitation or contact: ________________________________________________ ______ 8. The petitioner(s) have completed the list of interested persons in Part I and have attached or explained in an attached affidavit the absence of the documents listed in Part III. 9. Any law governing interstate or intercountry adoption was complied with, if applicable. 10. The petitioners have the facilities and resources to provide for the care and support of the child and request that they be permitted to adopt the child. In addition, the following relief is sought: ________________________________________________________________ __________________________________________________________________________ ___________________________________________________________________________ . <<<<<<<<<********>>>>>>>>>>>>> 3Form 131 Page 3Part II. Persons Interested in Adoption Proceeding The undersigned petitioner(s) represents that the following is a list of persons interested in the adoption of the above-named child as far as is known to me: 1. Mothers name: _________________________________________________________ Mailing address: ________________________________________________________ ________________________________________________________ Town of resdei nce: ________________________________________________________ 2. Name of husband of the mother, if the child was born during the marriage or within 300 days after its termination: ________________________________________________ _______ Mailing address: ________________________________________________________ _________________________________________________________ Town of resdei nce: ________________________________________________________ 3. Name of biological father identified by the mother: _______________________________ Mailing address: ________________________________________________________ _________________________________________________________ Town of resdei nce: ________________________________________________________ 4. Name of any other man who was not married to the mother at the time of the childs birth, has acknowledged paternity and has demonstrated a parentingrelationship with the child, including financial: __________________________________________
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