CJ-P 87 (3/31/14)
PETITION FOR ADOPTION AND AFFIDAVIT OF PETITIONER(S)
Commonwealth of Massachusetts The Trial Court Probate and Family Court
In the matter of:
To the Justices of the Probate and Family Court:
Petitioner's spouse (if married) must join in the petition:
Information about the Petitioner
1.
Primary Phone #:
The Petitioner(s) are desirous of adopting the following child:
2.
3.
Information about biological/legal parents:
(city/town and state or country)
4.
The Petitioner(s) are of sufficient ability to rear the child, and to provide suitable support and education for the child;
the child has resided for at least six months in the home of the Petitioner(s).
the child was the subject of a proceeding pursuant to G.L. c. 210, §3 where the Court dispensed with the need for
the child was the subject of a surrender which was executed pursuant to G.L. c. 210, §2.
At the time of the surrender the (biological/legal) mother was years old.
At the time of the surrender the (biological/legal) father was years old.
AND
consent of or notice to the parent(s) on a Petition for Adoption.
The Petitioner(s) request that the Court:
CJ-P 87 (3/31/14)
Information on Attorney for Petitioner(s), if any
This Petition is sponsored, recommended, and approved by:
a charitable corporation organized under the laws of the Commonwealth of Massachusetts for the purpose of engaging in the care of children and principally so engaged.
CONSENT OF CHILD
I,
, being above the age of twelve (12) consent to
this adoption.
NOTARIZATION
The above signed
made oath before me on
that this consent is his/her free act and deed.
CJ-P 87 (3/31/14)
AFFIDAVIT OF PETITIONER(S) FOR ADOPTION
Parent 1
Parent 2
Place of Birth:
Place of Birth:
I hereby request that a certificate of adoption be sent to the city or town clerk of the place of the birth of the child and that a clerk of the records amend the birth certificate of the child to reflect this adoption.
NOTARIZATION
The above signed made an oath before me on
The above signed made an oath before me on
that this affidavit is Petitioner's free act and deed.
that this affidavit is Petitioner's free act and deed.
SIGNATURE OF NOTARY PUBLIC
SIGNATURE OF NOTARY PUBLIC