CONFIDENTIAL COURT RECORD JC-1647, 11/17 Order on Petition for Minor Child Adoption 24724748.91 and 48.94, Wisconsin Statutes; 25 U.S.C. 2471915. This form shall not be modified. It may be supplemented with additional material. Page 1 of 1 STATE OF WISCONSIN, CIRCUIT COURT, COUNTY IN THE INTEREST OF Name Date of Birth Order on Petition for Minor Child Adoption Case No. THE COURT FINDS: 1. The petitioner(s), [Name(s)] , is/are a relative(s). a stepparent(s). the proposed adoptive parent(s) with whom the minor child was placed. 2. The minor child has lived with the petitioner(s) since [Date] . 3. The guardian does does not consent to this adoption. 4. The recommendation and written report of [Agency] was filed. 5. The minor child is suitable for adoption. The petitioner is a fit and proper person of reputable standing in the community with the ability to maintain and support this minor child. The adoption is in the best interests of the minor child. 6. All legal requirements concerning this adoption readoption were met. 7. The adoptive parent(s) has requested that the birth certificate not be changed. 8. The provisions of the Indian Child Welfare Act do not apply. An inquiry has been made on the record to each participant in this proceeding as to whether the participant knows or has reason to know that the minor child is an Indian child. [For an Indian child, use the Indian Child Welfare Act version (IW-1647).] THE COURT ORDERS: The Petition for Adoption is 1. granted. A. The name of this minor child shall be changed to . B. The birth certificate for this minor child shall shall not be changed. 2. denied for the following reason(s): . THIS IS A FINAL ORDER FOR THE PURPOSE OF APPEAL. DISTRIBUTION: 1. Court 2. Adoptive Parent(s) American LegalNet, Inc. www.FormsWorkFlow.com