FOR COURT USE ONLY ATTORNEY OR PARTY WITHOUT ATTORNEY (N ame, State Bar Number and Address) TELEPHONE NO.: FAX NO: (Optional) ATTORNEY FOR (NAME): PETITIONER: PETITION TO DECLARE MINOR FREE FROM PARENTAL CUSTODY AND CONTROL OF PARENT FOR STEPPARENT ADOPTION CASE NUMBER: AMADOR COUNTY SUPERIOR COURT 500 ARGONAUT LANE JACKSON, CA 95642 (209) 257 - 2600 Petitioner alleges: 1.Petitioner , is thestepfather/stepmother of the subject minor child , and seeks an order freeing the minor from custody and control of the father/mother , and termination of parental rights as to the minor. 2.Petitioner is seeking to adopt , and aRequest for adoption has been filed in the Superior Court of the County of Amador.WHEREFORE, Petitioner prays as follows: 1.For an order declaring the minor child, , free from custodyand paternal control of , and terminating all of his/her parentalrights and responsibilities with respect to the minor child, .2.For such other relief as the court may deem proper. Dated Petitioner PETITION TO DECLARE MINOR FREE FROM PARENTAL CUSTODY AND CONTROL OF PARENT FOR STEPPARENT ADOPTION www.amadorcourt.org FC-200 Approved for Optional American LegalNet, Inc. www.FormsWorkFlow.com