Fillable Petition To Adopt Minor By Stepparent (Vermont Judiciary)

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Petition To Adopt Minor By Stepparent (Vermont Judiciary)

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700-00131B_C – Petition to Adopt Minor by Stepparent (08/2019) Page 1 of 4
STATE
OF
VERMONT
SUPERIOR COURT
PROBATE DIVISION
Unit
Docket No.
PETITION TO ADOPT MINOR BY STEPPARENT
OR DOMESTIC PARTNER OF CUSTODIAL PARENT
I/We ask the Court to permit me/us to adopt the minor child named above. I/We swear or affirm under oath
that the facts set forth below are true to the best of my knowledge and belief:
Information About the Minor Child to be Adopted
Child’s Full Birth or Current Legal Name: _______________________________________________________
Date of Birth: _____________________________ Time of Birth: ____________AM ___________PM
Place of Birth (town, state, zip): ______________________________________________________________
Name by which Child will be known After Adoption: ______________________________________________
Gender of Child: ☐ Male ☐ Female
Describe any assets or property owned by the child and the value of each asset
Asset Value
_________________________________________________ $_________________
_________________________________________________ $_________________
_________________________________________________ $_________________
Request for New Birth Certificate:
☐ No Request was made by Petitioners
☐ Petitioners have requested that a new birth certificate be issued by the Supervisor of Vital Records that
includes the name, date of birth, and place of birth of the adoptive parent(s) as set forth below.
Petitioner Information
My Name: _______________________________________________________________________________
Date of Birth: ___________________________________ Place of Birth: ____________________________
Complete Mailing Address (town, state, zip):_______________________________________________________
Length of time residing at this residence: _____________ Phone Number: ___________________________
Describe your relationship to the Child:
______________________________________________________________________________________
______________________________________________________________________________________
Occupation: ____________________________________ Annual Income: $__________________________
I have the resources and the facilities to provide the care and support for this Child: ☐ Yes ☐ No
1) I state that to the best of my knowledge and belief, the minor is not subject to the Indian Child Welfare
Act, 25 U.S.C. §1901 et seq.
2) I state to the best of my knowledge and belief, any law governing interstate or inter-country placement
which applies to this adoption has been complied with.
700-00131B_C – Petition to Adopt Minor by Stepparent (08/2019) Page 2 of 4
Information About the Biological Parents - provide all information that you know
Full Name of Parent A: __________________________________________________________________
Complete Mailing Address: __________________________________________________________________
Town & State of Residence: __________________________________________________________________
Mailing Address (if different): __________________________________________________________________
Full Name of Parent B: __________________________________________________________________
Complete Mailing Address: __________________________________________________________________
Town & State of Residence: __________________________________________________________________
Mailing Address (if different): __________________________________________________________________
☐ I do not know some or all of the information about the other parent because (briefly explain):
_______________________________________________________________________________________
_______________________________________________________________________________________
Consent, Relinquishment or Disclaimer of Parental Interest
The following person(s) has/have signed a consent, relinquishment or disclaimer of parental interest:
Name Relationship to Child Type of Document Signed
__________________________ ____________________ _____________________
__________________________ ____________________ _____________________
__________________________ ____________________ _____________________
The following person(s) has a parental relationship that has not been terminated and a consent or
relinquishment may be required:
Name Relationship to Child Facts that may Explain
Lack of Consent
__________________________ ____________________ _____________________
__________________________ ____________________ _____________________
__________________________ ____________________ _____________________
Prior Adoption Petitions
I have previously filed an adoption petition in another court: ☐ Yes ☐ No
If yes, describe what happened to your petition:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Prior or Pending Court Proceedings Involving this Child
Describe any Court proceedings or Court Orders related to this child concerning child support, custody (parental rights and
responsibilities) or visitation (parent child contact). Use additional sheets if necessary
Name of Court Docket Number Type of Court Proceeding
__________________________ ____________________ _____________________
__________________________ ____________________ _____________________
__________________________ ____________________ _____________________
700-00131B_C – Petition to Adopt Minor by Stepparent (08/2019) Page 3 of 4
Information Related to Marital Status:
☐ Single/Never Married ☐ Married
☐ In a Civil Union ☐ Single/Divorced
☐ Spouse/Partner Deceased
If married or in a Civil Union, complete the following information:
Date of Marriage/Union: _________________________ Place of Marriage/Union: ___________________
Spouse/Partner’s Date of Birth: ____________________ Spouse/Partner’s Place of Birth: ______________
If married, has spouse been judicially determined to be incompetent:
☐ Yes ☐ No
If Yes, please provide the date of determination: _________________________________________________
If spouse/partner is deceased, please provide the following information:
Date of Death: _____________ Place of Death: _______________ Cause of Death: _______________
Current Residence of Minor Child
☐ The child has resided with the petitioner since ________________________________.
☐ The child is not currently residing with petitioner because:
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Legal Custody of Minor
I/We have legal custody of the minor
:
☐ Yes ☐ No
If yes, describe the circumstances under which you obtained custody of the minor:
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Information about Living Maternal Grandparents
Full Name of Living Maternal Grandmother: _____________________________________________________
Complete Mailing Address: __________________________________________________________________
Town & State of Residence: __________________________________________________________________
Mailing Address (if different): __________________________________________________________________
Phone Number: __________________________________________________________________
Full Name of Living Maternal Grandfather: ______________________________________________________
If contact information for maternal grandfather is different than maternal grandmother, please complete the information below
Complete Mailing Address: __________________________________________________________________
Town & State of Residence: __________________________________________________________________
Mailing Address (if different): __________________________________________________________________
Phone Number: __________________________________________________________________
700-00131B_C – Petition to Adopt Minor by Stepparent (08/2019) Page 4 of 4
Information about Living Paternal Grandparents
Full Name of Living Paternal Grandmother: _____________________________________________________
Complete Mailing Address: __________________________________________________________________
Town & State of Residence: __________________________________________________________________
Mailing Address (if different): __________________________________________________________________
Phone Number: __________________________________________________________________
Full Name of Living Paternal Grandfather: ______________________________________________________
If contact information for maternal grandfather is different than maternal grandmother, please complete the information below
Complete Mailing Address: __________________________________________________________________
Town & State of Residence: __________________________________________________________________
Mailing Address (if different): __________________________________________________________________
Phone Number: __________________________________________________________________
Home Study
☐ A home study is being prepared by (name and address of preparer): ___________________________________________
_______________________________________________________________________________________
☐ I request a waiver of the home study
:
☐ Yes ☐ No
If you are requesting a waiver, you must attach a letter to the Court explaining in detail why a waiver would be appropriate.
I swear or affirm that the facts set forth in this consent are true and correct to the best of my knowledge and
belief.
On:
Date
At:
Signature of Petitioner
City, County and State
Printed Name
Signed and sworn to before me:
IF PETITIONER IS MARRIED OR IN A CIVIL UNION, PETITIONER’S SPOUSE/PARTNER MUST CONSENT TO THE
PETITION BY SIGNING BELOW UNLESS THE SPOUSE/PARTNER HAS BEEN JUDICIALLY DECLARED INCOMPETENT.
☐ I am the spouse/partner of the petitioner and I consent to the filing of this petition
On:
Date
At:
Signature of Spouse/Partner
City, County and State
Printed Name
Date Signature of Notary Public Expiration Date
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Petition To Adopt Minor By Stepparent (Vermont Judiciary)

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Completed 15 July 2020

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