FOR COURT USE ONLY ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, address and telephone #): STATE BAR NO: ATTORNEY FOR (Name): SUPERIOR COURT OF CALIFORNIA, COUNTY OF MARIN 3501 Civic Center Drive P.O. Box 4988 San Rafael, CA 94913-4988 IN THE MATTER OF THE PETITION OF: ON BEHALF OF: A CHILD, PETITION TO DECLARE CHILD FREE FROM CUSTODY AND CONTROL OF EITHER OR BOTH PARENTS CASE NUMBER: Petitioner alleges: 1. Petitioner is an adult person and desires to adopt ________________________________________________, a child who is the subject of this petition. Petitioner is the __________________ of _________________________ _________________________________, who is the ____________________________ of the child and who has custody of the child. Petitioner, ________ spouse and the child reside in Marin County, California. 2. The whereabouts of ________________________________________, the natural _________________ of the child, are unknown. , 3. The child has been left by the natural _______________ in the custody and control of the ______________ of the child. The natural ____________________ of the child has not communicated with the child or made any provisions or the support of the child since ________________________________, a period of over one year. Wherefore, petitioner asks judgment declaring that the child is free from the custody and control of _______________________________________. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date: . . . . . . . . . . . . . . . . . . . . . . . . (TYPE OR PRINT NAME) CV022WB ► SIGNATURE OF PERSON COMPLETING THIS FORM PETITION TO DECLARE CHILD FREE FROM CUSTODY AND CONTROL OF EITHER OR BOTH PARENTS Rev. 7/07 American LegalNet, Inc. www.FormsWorkflow.com