ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address): FOR COURT USE ONLY TELEPHONE NO.: E-MAIL ADDRESS (Optional): ATTORNEY FOR (Name): FAX NO. (Optional): SUPERIOR COURT OF CALIFORNIA, COUNTY OF IMPERIAL 939 W. MAIN STREET EL CENTRO, CA 92243 IN THE MATTER OF: PETITIONER. ADOPTION CITATION TO DECLARE MINOR FREE FROM PARENTAL CUSTODY AND CONTROL OF PARENT FOR STEPPARENT ADOPTION CASE NUMBER: To (name): _________________________________________________________ (Parents Whose Rights May Be Terminated) By order of the Court, you are hereby advised that you are requested to appear before the judge presiding in Department _____ of this Court on ___________ (Date) at 8:30 a.m. to show cause, if any you have, why ___________________ (Child's Name), a minor, should not be declared free from custody and control of his/her parent__________________. TAMMY L. GRIMM, CLERK OF THE COURT Dated: by Deputy Clerk , DO NOT use for conservatorships or for guardianships of adults. Form Approved for Optional Use AD-04 (Adopted 01/01/12, Revised 01/01/13, 01/01/15) ADOPTION CITATION TO DECLARE MINOR FREE FROM PARENTAL CUSTODY AND CONTROL OF PARENT FOR STEPPARENT ADOPTION imperial.courts.ca.gov American LegalNet, Inc. www.FormsWorkFlow.com