Fillable PAD Self-Represented DISTRICT COURT CLARK COUNTY, NEVADA In (Family Law Self Help Center)

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PAD Self-Represented DISTRICT COURT CLARK COUNTY, NEVADA In (Family Law Self Help Center)

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© 2018 Family Law Self-Help Center Petition for Adult 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’ name(s))
For the adoption of
_
_________________________________,
(name of person to be adopted)
An adult.
CASE NO.: ____________________
DEPT: ____________________
PETITION FOR ADULT ADOPTION
Petitioners respectfully state as follows:
1. Parties. Petitioners are:
Name of Adoptee:
Name of First Adoptive Parent:
Name of Second Adoptive Parent:
List “not applicable” if the 2
nd
parent is already listed on the
birth certificate, or if there will only be one legal parent
2. Agreement. Petitioners have executed an Agreement of Adoption, which is attached as
Exhibit 1.
Page 2 of 8 - Petition for Adult Adoption
3. Reason. The Petitioners wish to establish a parent-child relationship because: (explain
why you want the judge to grant the adoption):
4. Birth Certificate. Upon approval of the adoption, the adult’s birth certificate should
identify the following legal parents (list the names of all legal parents who should be
listed on the birth certificate. If a parent’s name will stay on the birth certificate, write
the parent’s name below exactly as it currently appears on the birth certificate):
First Parent: __________________ __________________ __________________
(first) (middle) (last)
Second Parent: _________________ __________________ __________________
(first) (middle) (last)
The following names should be REMOVED as legal parents on the birth certificate (list
the names of all parents currently named on the birth certificate who should be
removed):
Remove: ____________________ __________________ __________________
(first) (middle) (last)
Remove: ___________________ __________________ __________________
(first) (middle) (last)
Page 3 of 8 - Petition for Adult Adoption
5. Name Change. The adoptee can request a name change. The Court may require you to
publish a notice of your name change in the newspaper one time. If approved, you will
be known by the new name in the future, and all of your ID will have to be changed.
No name change is requested (if no name change is requested, SKIP to page 4).
The person to be adopted wishes to add a claim for relief under NRS 41.270 to
change his/her name because (explain the reason you want to change your name)
Petitioner is not requesting this name change to defraud creditors or for some other
fraudulent reason.
Has the person to be adopted ever been convicted of a felony?
No, the person to be adopted has never been convicted of a felony.
Yes, the person to be adopted has been convicted of a felony. The details of my
convictions are (list all felony convictions, including the offense, date of conviction,
and the county/state):
*If you have a felony conviction, you must provide a complete set of fingerprints
taken in the manner described by the Department of Public Safety at the time you
file this petition.
The name of the person to be adopted should be changed from:
_____________________ ______________________ _______________________
(current first) (current middle) (current last)
who at the time of birth was given the name of
_____________________ ______________________ _______________________
(birthname first) (birthname middle) (birthname last)
to:
_____________________ ______________________ _______________________
(new first) (new middle) (new last)
Page 4 of 8 - Petition for Adult Adoption
Petitioners request:
1. An order approving the attached agreement of adoption and issuance of a Decree of
Adoption pursuant to NRS 127.210;
2. That the adoptee henceforth bear the name(s) requested; and
3. For such other relief as the Court finds to be just and proper.
DATED (month) ______________________ (day) _____________, 20___.
VERIFICATION OF THE PERSON TO BE ADOPTED
I, (name of person to be adopted) _______________________________________,
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.
__________________________________________
ADOPTEE
(First Adoptive Parent Signature)
(First Adoptive Parent Printed Name)
(Person to be Adopted Signature)
(Person to be Adopted Printed Name)
(Second Adoptive Parent Signature)
(Second Adoptive Parent Printed Name)
Page 5 of 8 - Petition for Adult Adoption
ADOPTIVE PARENT’S VERIFICATION
I, (name of first adoptive parent) _______________________________________,
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.
__________________________________________
FIRST ADOPTIVE PARENT
ADOPTIVE PARENT’S VERIFICATION
I, (name of second adoptive parent) _______________________________________,
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.
__________________________________________
SECOND ADOPTIVE PARENT
Page 6 of 8 - Petition for Adult Adoption
EXHIBIT 1
AGREEMENT FOR ADULT ADOPTION
Petitioners submit this agreement pursuant to NRS 127.190 and respectfully state:
1. Person to Be Adopted. The person to be adopted is
_____________________ ______________________ _______________________
(current first) (current middle) (current last)
and at the time of birth was given the name of
_____________________ ______________________ _______________________
(birthname first) (birthname middle) (birthname last)
The person to be adopted was born (date of birth) _______________________________
in (city) _____________________________, (state) ____________________________,
and is currently (age) ______ years old.
2. Residence Address. The person to be adopted lives at:
___________________________________________________
Address
___________________________________________________
City, State, Zip Code
The adult has lived at the above address since (date) ______________.
3. Spouse of the Person to Be Adopted.
The person to be adopted is not married.
The person to be adopted is married. The spouse’s name is (spouse’s name)
_______________________________________________. The spouse will sign a
consent agreeing to this proposed adoption.
Page 7 of 8 - Petition for Adult Adoption
4. First Adoptive Parent. The person who wants to adopt the adult named above is:
(adoptive parent’s name) ________________________________________________,
age (age) ________.
The adoptive parent is not married.
The adoptive parent is married. The spouse’s name is (spouse’s name)
_______________________________________________. The spouse will sign a
consent agreeing to this proposed adoption.
5. Adoptive Parent’s Residence Address:
___________________________________________________
Address
___________________________________________________
City, State, Zip Code
The adoptive parent has lived at the above address since (date) ______________.
6. Second Adoptive Parent.
Not applicable; there is only one adoptive parent (SKIP TO # 8).
The second person who wants to adopt the adult is married to the First Adoptive
Parent (named above). The second adoptive parent is (adoptive parent’s name)
___________________________________________, age (age) ________.
7. Second Adoptive Parent’s Residence Address:
___________________________________________________
Address
___________________________________________________
City, State, Zip Code
The adoptive parent has lived at the above address since (date) ______________.
Page 8 of 8 - Petition for Adult Adoption
8. The parties agree to assume toward each other the legal relation of parent and child, and
to have all of the rights and be subject to all of the duties and responsibilities of that
relation.
9. It is the desire of the petitioners that the relationship of parent and child be established
between them.
DATED (month) ______________________ (day) _____________, 20___.
(First Adoptive Parent Signature)
(First Adoptive Parent Printed Name)
(Person to be Adopted Signature)
(Person to be Adopted Printed Name)
(Second Adoptive Parent Signature)
(Second Adoptive Parent Printed Name)
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PAD Self-Represented DISTRICT COURT CLARK COUNTY, NEVADA In (Family Law Self Help Center)

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Completed 9 February 2021

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