© 2016 Family Law Self-Help Center Petition for Adoption
* You are responsible for knowing the law about your case. For more information on the law, this form, and free classes,
visit www.familylawselfhelpcenter.org or the Family Law Self Help Center at 601 N. Pecos Road. To find an attorney,
call the State Bar of Nevada at (702) 382-0504.
1
PAD
Name: ______________________________
Address: ____________________________
City, State, Zip: _______________________
Phone: ______________________________
Email: ______________________________
Self-Represented
DISTRICT COURT
CLARK COUNTY, NEVADA
In the Matter of the Petition of
_
_____________________________ and
_
_____________________________
(adoptive parents’ names)
For adoption of a minor child.
CASE NO.: ____________________
DEPT: ____________________
PETITION FOR ADOPTION
Petitioners respectfully state:
1. Petitioners are:
(Name of first petitioner) ______________________________, age (age) ________.
(Name of second petitioner) ______________________________, age (age) ________.
Petitioners are more than ten years older than the child(ren) to be adopted, or are related
to the child(ren) pursuant to NRS 127.020(2)(a).
2. Petitioners have been residents of the State of Nevada since (date) _________________
and have been married since (date of marriage) _______________________.
3. Petitioners wish to adopt the following child(ren):
Child’s Full Name: Date of Birth Age
Page 2 of 4 - Petition for Adoption
4. Petitioners are related to the child(ren) as follows ( check one):
Parent and Stepparent of the child(ren).
Grandparents of the child(ren).
Aunts/Uncles of the child(ren).
Siblings of the child(ren).
5. The child(ren) have resided with the petitioners in their home since (date the child(ren)
first came to live with you) ______________________.
6. Child(ren)’s Mother.
The full name of the child(ren)’s mother is: (name) ______________________________.
( check one):
The mother is one of the petitioners to this adoption, and her spouse desires to
adopt the child(ren).
The mother voluntarily consents to the termination of her parental rights and this
adoption. A proper consent will be filed with the court.
The mother’s rights were terminated by (name of court) ____________________
case number (case #) _________________ on (date) ______________.
*Attach a copy of the order as an exhibit.*
The mother is deceased.
7. Child(ren)’s Father.
The full name of the child(ren)’s father is: (name) _______________________________.
( check one):
The father is one of the petitioners to this adoption, and his spouse desires to
adopt the child(ren).
The father voluntarily consents to the termination of his parental rights and this
adoption. A proper consent will be filed with the court.
The father’s rights were terminated by (name of court) ____________________
case number (case #) _________________ on (date) ______________.
*Attach a copy of the order as an exhibit.*
The father is deceased.
Page 3 of 4 - Petition for Adoption
8. Upon information and belief, the child(ren) are not known to be of Indian descent.
9. It is the desire of the petitioners that the relationship of parent and child be established
between them and the child(ren).
10. The petitioners are fit and proper persons to have the care and custody of the child(ren).
11. The petitioners are financially able to care for the child(ren).
12. There has been a full compliance with the law in regard to consent to adoption.
13. There has been a full compliance with NRS 127.220 to 127.310, inclusive.
14. Petitioners wish to change the child(ren)’s names as follows:
Child’s Current Full Name: Child’s New Full Name:
Petitioners request:
1. An order awarding the custody of the minor child(ren) to them declaring that the
child(ren) shall henceforth be regarded and treated in all respects as the child of
the petitioners;
2. That the child(ren) henceforth bear the name(s) requested; and
3. For such other relief as the Court finds to be just and proper.
Date: _____________________________
________________________________
(First Petitioner’s signature)
________________________________
(First Petitioner’s printed name)
Date: _____________________________
________________________________
(Second Petitioner’s signature)
_________________________________
(Second Petitioner’s printed name)
FIRST PETITIONER’S VERIFICATION
I, (name of first petitioner) _______________________________________, declare that
I am the Petitioner in the above-entitled action; that I have read the foregoing Petition for
Adoption and know the contents thereof; that the pleading is true of my own knowledge, except
for those matters therein contained stated upon information and belief, and that as to those
matters, I believe them to be true.
I declare under penalty of perjury under the law of the State of Nevada that the
foregoing is true and correct.
DATED this (day) _____ day of (month) ___________________, 20___.
____________________________________
(First Petitioner’s signature)
SECOND PETITIONER’S VERIFICATION
I, (name of second petitioner) _______________________________________, declare
that I am the Petitioner in the above-entitled action; that I have read the foregoing Petition for
Adoption and know the contents thereof; that the pleading is true of my own knowledge, except
for those matters therein contained stated upon information and belief, and that as to those
matters, I believe them to be true.
I declare under penalty of perjury under the law of the State of Nevada that the
foregoing is true and correct.
DATED this (day) _____ day of (month) ___________________, 20___.
____________________________________
(Second Petitioner’s signature)