ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address):
TELEPHONE NO.: FAX NO.:
EMAIL ADDRESS:
ATTORNEY FOR (Name):
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
STREET ADDRESS:
MAILING ADDRESS:
CITY AND ZIP CODE:
BRANCH NAME:
IN THE MATTER OF THE PETITION OF:
PETITION TO TERMINATE PARENTAL RIGHTS OF ALLEGED FATHER
The petitioner(s) ____________________________________________________________________ respectfully
represent(s) and allege(s):
1. That the minor child involved in these proceedings is _________________________________________, born on
__________________________. Said minor is presently in the County of San Bernardino, State of California, in the
custody of _____________________________________, for the purpose of adoption.
2. That petitioner is a person or representative of an agency described in §7662 of the Family code as a party authorized
to file this petition.
3. That ___________________________________________________________ is the mother of said minor
4. a.
□That the minor’s mother was married at the time the minor was born.
b. □That minor’s mother was not married at the time minor was born, nor for 300 days preceding the birth.
5. That the natural father of said minor is ______________________________________________________, who
resides at
_______________________________________________________________________________________________.
6. a.
□That the minor’s mother and said father did not cohabit.
b.
□That the minor’s mother and said father cohabited for the period from ____________________________ to
_________________________________________________________.
7. That the minor’s mother and said father did not attempt to marry each other before or after the birth of said child.
8. That the father did not openly hold out the child as his natural child and receive it as such into his home.
9. That no child support payments, other than token amounts, have been made by said father, voluntarily, or pursuant
to court order, to petitioner or any other person for the support of said minor, and he has failed to communicate with
said minor.
10. That no action has been brought, nor is any action pending for the purpose of having declared the existence or non-
existence between the parties of the relation of parent and child.
11.
□(If father is unknown): That the facts concerning the conception are _________________________________
______________________________________________________________________________________________.
13-21903-360 PETITION TO DETERMINE PARENTAL RIGHTS OF ALLEGED FATHER Family Code §7660
Revised 8/10/2016 Page 1 of 2
