Stepparent Adoption - DOC

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					                                    Stepparent Adoption
1. Stepparent’s Information:         Stepmother    Stepfather
   Full Name____________________________________________ Date of Birth________________
   Address________________________________ City ___________ State_______ Zip ________
   Place of Birth_____________________________________ Phone_________________________
   Place of Current Marriage___________________________ Date of Marriage_______________
   S.S. #_______________________________ Spouse’s S.S. #_______________________________
   * Please attach a copy of your Marriage License

2. Adoptive Parent’s Previous Marriages (Please include the date of marriage and a description
   termination)______________________________________________________________________
   _________________________________________________________________________________

3. Natural Parent’s Information (please include their full name and current/last known address):
   Father’s Full Name________________________________________________________________
   Address________________________________ City ___________ State_______ Zip _________
   Mother’s Full Name_______________________________________________________________
   Address________________________________ City ___________ State_______ Zip _________

   Were the Natural Parents Married?           Yes    No
   If answered “Yes”, Place of Marriage______________________ Date of Marriage___________
   Date of Dissolution_______________________ County of Divorce_________________________
   Case #____________________________ Who was awarded custody?         Mother      Father
   * Please attach a copy of the latest Custody Order

   If Deceased, State Name______________________________ Date of Death__________________
   * Please attach a copy of the Death Certificate

   Do the Natural Parents consent to this adoption?        Yes       No

4. Has the Natural Parent:
   Visited the child/children?     Yes        No     Date of the last visit________________________
   *If answered “No”, please file a Petition to Terminate the Parental Rights of the absent parent form
   Paid Child support?      Yes        No        Date of the last payment________________________
   Can you located the Natural Parent?         Yes       No
   * If answered “No”, you need to publish. Please attach a Petition to Publish
5. Please list the child/children you want to adopt:

               Child's Full Name               Date of Birth     Place of Birth      Age   Sex




6. Residence Information (Last 5 Years)

   Name of Child 1________________________________________ S.S.#_______________________
  Period of       Address Where Child Lived            Name and Current Address of     Relationship
  Residence        (Include City and State)              Person Child Lived With       to Child
 To: Present
 From:
 To:
 From:
 To:
 From:

   Name of Child 2________________________________________ S.S.#_______________________
  Period of       Address Where Child Lived            Name and Current Address of     Relationship
  Residence        (Include City and State)              Person Child Lived With       to Child
 To: Present
 From:
 To:
 From:
 To:
 From:

   Name of Child 3________________________________________ S.S.#_______________________
  Period of       Address Where Child Lived            Name and Current Address of     Relationship
  Residence        (Include City and State)              Person Child Lived With       to Child
 To: Present
 From:
 To:
 From:
 To:
 From:
7. Optional Name Change (Please enter the child/children’s new full name):
   _________________________________________________________________________________
   _________________________________________________________________________________
   _________________________________________________________________________________

8. Please attach copies of the following documents:
       Marriage certificates – current and prior marriages of both you and your spouse
       Most current Court Order (Custody arrangement)
       Certified copy of the child/children’s birth certificate(s)
       Military Discharge papers of you or your spouse
       Death certificate (if applicable)

				
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posted:10/5/2012
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