IN THE SUPERIOR COURT FOR THE STATE OF ALASKA AT In the matter of the adoption of ) ) ) ) ) ) ) ) ) ) ) (child's name after adoption) DOB: By , A Minor Child, Petitioner. Court Information , CASE NO. ADOPTION PETITION I. This is the correct court to hear this matter because: The child has an open CINA matter. Case number (if known) This is the location where the CINA proceedings are pending. While the CINA proceedings are not in this location, the petitioner resides in this district and: does not know the CINA parties and asks the Alaska Court System to send notice. has filed notice to the CINA parties. Proof of notice is attached to this petition. Proof of consent is attached to this petition. There is no open CINA matter for the child, and this location is where: The person(s) seeking to adopt the child resides or is in the military. The child resides at the time of filing. The agency that has care, custody, or control of the child is located. II. Child's Information . a. Child's current full name (leave blank if an agency adoption): b. Child's name after adoption: c. Child was born on (date) , in (city) , (state or country) . d. Child's current address: e. Number of years child has lived at the above address: f. Name of birth parents, if known: g. The child has no property of significant value, except: Page 1 of 5 P-405 (3/17)(cs) PETITION FOR ADOPTION AS 25.23.080 Adoption Rule 6 American LegalNet, Inc. www.FormsWorkFlow.com [Includes money in bank accounts, ANCSA Corporation shares, real property, jewelry etc.] Description of Property Estimated Value h. Does the child qualify as an Indian child? (Child is a member of an Indian tribe; or child is eligible for membership in a tribe and either of the child's biological parents is a member of an Indian tribe.) No. Yes. Fill out P-450, Report of Indian Adoptive Placement. i. To my knowledge and belief, there are are not any other court cases involving this child now pending in a state or tribal court in Alaska or in another state (including tribal courts). Type of Court Case Where Case No., if known III. Petitioner Information a. Name of Adopting Parent(s): b. Marital Status: not married. married. Spouse's name: Marriage occurred on c. Address: d. Number of years you have lived in the above city: e. Telephone Number: f. I/we have a place to live and resources suitable to provide for the nurture and care of the child and I/we desire to establish the relationship of parent and child with this child. (date) . , in (city) (state) . Page 2 of 5 P-405 (3/17)(cs) PETITION FOR ADOPTION AS 25.23.080 Adoption Rule 6 American LegalNet, Inc. www.FormsWorkFlow.com IV. Adoption Information Private agency adoption. Name of Agency: State agency adoption. Name of Agency: Non-Agency/Independent adoption Relative Nonrelative Stepparent adoption a. What kind of adoption is this? b. Is this an adoption of an Indian child? No. Yes. I/we should be the adoptive parent because: I am a member of the child's extended family. I am another member of the child's tribe. I am a member of another Indian tribe. I believe there is good cause to deviate from the Indian Child Welfare Act's adoptive placement preferences. (See 25. U.S.C. 1915(a).) c. Consent. 1. All the following persons whose consent is required by Alaska Statute 25.23.040 have consented to this adoption: The mother of the minor. The father of the minor. The minor, if the minor is age 10 or older. Any spouse of the child to be adopted. Any other person who is lawfully entitled to custody of the child or empowered to consent. Person or agency's name: . Consent forms from each of the above persons accompany this petition. I understand that consent or relinquishment must be signed in a hearing in the presence of a judge or a special master when: the consenting parents are the parents of an Indian child, the consenting parent is a minor, or the consenting child to be adopted is over the age of 10. Page 3 of 5 P-405 (3/17)(cs) PETITION FOR ADOPTION AS 25.23.080 Adoption Rule 6 American LegalNet, Inc. www.FormsWorkFlow.com 2. If consent is not required because of a reason recognized in AS 25.23.050, please state the reason. Name of person whose consent is not needed: Reason d. Visitation after the Adoption. AS 25.23.130. 1. The parent consenting to the adoption of the child has requested that he/she/other will will not be allowed visitation with the child following the relative adoption, as specified in that parent's consent/relinquishment. 2. I f. agree do not agree with this request. e. I believe that this adoption is in the best interests of this child. I/we also filed the following: 1. a certified copy of the child's birth certificate (or verification of the birth record), 2. a filled out form VS-5501, Descriptive Information Regarding Biological Parents, 3. a filled-out form VS-5011, Report of Adoption, 4. the required consent forms, and 5. the report of expenditures required by AS 25.23.090 (not required for a stepparent adoption). [If I am unable to provide any of the above five requirements at the time of filing, my petition will still be accepted by the court, however, my petition will be deficient until complete.] g. I/we ask the court to: 1. grant this petition for adoption and declare the child to be my child for all legal purposes, 2. declare that the child will be known from now on by the name shown at the top of page one of this petition, and 3. order that a new birth certificate be issued for the child. yes no 1 VS-550 and VS-501 may be requested from Vital Statistics by email at BVSSpecialServices@alaska.gov; by phone at (907)465-3162; in person in Juneau at 5441 Commercial Blvd, Juneau, AK; or in person in Anchorage at 3601 C St., Suite 128, Anchorage, AK. Page 4 of 5 AS 25.23.080 P-405 (3/17)(cs) Adoption Rule 6 PETITION FOR ADOPTION American LegalNet, Inc. www.FormsWorkFlow.com [DO NOT SIGN YET. This must be signed in front of a clerk of court, notary public, or other person authorized to administer oaths.] I state on oath or affirm that I have read this petition and that all statements made in it are true to the best of my knowledge and belief. Date Date Signature of Adoptive Parent Signature of Adoptive Parent Verification Subscribed and sworn to or affirmed before me at , Alaska on . (date) (SEAL) Clerk of Court, Notary Public, or other person authorized to administer oaths. My commission expires: Certificate of Service [File this petition with the court. If the adoption invol