Name __________________________________ __________________________________ Address __________________________________ Phone __________________________________ Petitioner Pro Se _____________ DISTRICT COURT, ___________________ COUNTY, UTAH Address ______________________________________________________________ __________________________________________________________________________ * VERIFIED PETITION * FOR REGISTRATION * OF ADOPTION ORDER * FROM FOREIGN COUNTRY * __________________________________, * Case No. _________________ * A MINOR CHILD. * Judge: ____________________ ________________________________________________________________________ IN THE MATTER OF: TO THE HONORABLE COURT: My name is _______________________________________________________. I was born on _____________(date). I live at the address shown above. ___________________________________________________________ (name of child) is a child who lives with me and who I first met on ___________________ (date) at: _____________________________________________________________________ _______________________________________ (place -write complete address). I have learned the following information about the child: Date of birth: ____________________ 1 American LegalNet, Inc. www.FormsWorkFlow.com 8/04 Place of birth (write complete address, including city, province, country): __________________________________________________________________ Sex of child: G Male G Female Birth Mother's name: __________________________________________________ Birth Father's name: ____________________________________________________ I adopted the child in court in the following foreign country: _____________________ _________________________________________________________________. The adoption decree was signed on ___________________ (date). A copy of the court adoption decree is attached. G I have attached a certified translation and a certificate of the translator because the adoption decree is not in English. Another person also adopted the child along with me. This person is: Name: Address: __________________________________________________ _________________________________________________ _________________________________________________ Date of birth: _________________________ PLEASE register this adoption and sign an order that the Registrar for the State of Utah prepare a birth certificate for the child in the name of _______________________________________________________________________. (First) (Middle) (Last) Signed on ___________________ (date) _________________________________ Petitioner's Signature 2 American LegalNet, Inc. www.FormsWorkFlow.com 8/04 Petitioner, ______________________________ (name), appeared before me on the _______ day of _________________________, 20 _____, and proved to me Petitioner's identity in the form of a __________________________________. After being sworn and while under oath, Petitioner stated that Petitioner had read this document, understood the contents, and the contents were true of Petitioner's personal knowledge. Petitioner then signed this document in my presence. __________________________________ Notary Public Petitioner's Address: ____________________________________ ____________________________________ ____________________________________ 3 American LegalNet, Inc. www.FormsWorkFlow.com 8/04