ADOPT-216 Verification of Compliance with Hague Adoption Convention Attachment Clerk stamps date here when form is filed. (Attach to Adoption Order (form ADOPT-215) in cases proceeding under the Hague Adoption Convention.) 1 Determination of Application of Hague Adoption Convention (to be completed by adopting parent(s)): a. If applicable, please state the permanent address outside the United States of the adopting parent(s): Superior Court of California, County of b. Will you be moving the child to permanently reside in another Yes No country? c. If your answer to 1(b) is yes, what is the name of the other country? Court fills in case number when form is filed. d. If your answer to 1(b) is yes, when will the move occur? Case Number: e. Has the child lived in any other country since his/her birth? f. Yes No If your answer to 1(e) is yes, please indicate the country and the length of time the child resided there. (country): (length of time resided in country): g. What is the child's citizenship? h. Please state date(s) for any contact between the prospective adoptive parent(s) and the child's birth parent(s) or any other person who has had care of the child and describe the contact: i. Please state the amount and purpose of any payments made by the adopting parent(s) to the birth parent(s) or any other person who has had care of the child: 2 Court Findings (to be completed by the judge) The court finds as follows: The Hague Adoption Convention applies to this adoption. All parental rights have been terminated and the child has been declared free from the custody and control of his or her parents; thus, the child is adoptable. (Convention, art. 4(a).) Judicial Council of California, www.courts.ca.gov New July 1, 2013, Mandatory Form Family Code, §§ 8900, 8900.5, 8901, 8902, 8903, 8904, 8905, 8908, 8910, 8911, 8912, 8919, 8924, 8925; 22 Code of Federal Regulations Part 96, § 97.3; Hague Adoption Convention Verification of Compliance with Hague Adoption Convention Attachment ADOPT-216, Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com Case Number: Your name: By clear and convincing evidence, an intercountry adoption is in the best interest of the child. (Convention, art. 4(b).) The adoption services provider meets the requirements of 22 C.F.R. (Code of Federal Regulations) part 96. 3 Court Verifications (to be completed by the judge) The court verifies that the agency has met the substantive regulatory requirements of 22 C.F.R. § 97.3(a)­(k) in the following categories: Preparation of child background study (Convention, art. 16(1)(a); 22 C.F.R. § 97.3(a)); Transmission of child data to foreign authorized entity (Convention, art. 16(2); 22 § C.F.R. 97.3(b)); Reasonable efforts to find domestic placement (Convention, art. 4(b); 22 C.F.R. § 97.3(c)); Preparation and transmission of home study (Convention, art. 15; 22 C.F.R. § 97.3(d)); Authorization for the child to enter the receiving country (Convention, art. 5; 22 C.F.R. § 97.3(e)); Consent to the adoption/custody by foreign authorized entity (name of entity): (Convention, art. 17; 22 C.F.R. § 97.3(f)); Guardian/parent counseling and consent (specify): (Convention, art. 4(d); 22 C.F.R. § 97.3(g)); Child counseling and consent (if applicable)(specify): (22 C.F.R. § 97.3(h)); The agency and the Central Authority of the receiving country, as defined in Family Code section 8900.5(c), (name of receiving country): (name of central authority): have both signed Placement Adoption Papers (22 C.F.R. § 97.3(i)); The agency has taken all steps to ensure the secure transfer of the child, including obtaining permission for the child to leave the United States (Convention, arts. 18 & 19; 22 C.F.R. § 97.3(i)); The agency has taken all steps to keep the Central Authority of the receiving country informed about the adoption process, as well as the progress of the placement if a probationary period is required (Convention, art. 20; 22 C.F.R. § 97.3(i)); Proper observance of the "no-contact" rule, if applicable (22 C.F.R. § 97.3(j)); That no improper financial or other gain was derived (22 C.F.R. § 97.3(k)). 4 Court Orders The court grants Final adoption order. Final custody decree. Date: Judge (or Judicial Officer) New July 1, 2013 Verification of Compliance with Hague Adoption Convention Attachment ADOPT-216, Page 2 of 2