Attorney or Party without attorney (Name and Address) Telephone No.: Attorney for: SUPERIOR COURT OF CALIFORNIA, COUNTY OF SHASTA Mailing Address 1500 Court Street, Room 319 Street Address Redding, CA 96001 Branch IN THE MATTER OF PETITION FOR ADULT ADOPTION Case Number: A- An Adoption Petition must be completed and filed for each adoptee. 1. Adoptive Parent Name: __________________________________ Date of birth: ____________ Place of Birth: ________________________ Age: ______ Resident of: _______________County Name of your spouse: _____________________________________ Adoptive Parent Name: __________________________________ Date of birth: ____________ Place of Birth: _________________________ Age: ______ Resident of: _______________County Name of your spouse: _____________________________________ 2. Adoptee Name: __________________________ Date of birth: _____________________________ Place of Birth: __________________________ Age: ______ Resident of ______________County 3. Length and nature of the relationship of adoptive parent and the adoptee: _____________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ (If more space is necessary, please attach a separate page marked Exhibit “A”) 4. Degree of kinship if any: ___________________________________________________________ ________________________________________________________________________________ (If more space is necessary, please attach a separate page marked Exhibit “B”) 5. Reason the adoption is being sought: __________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ (If more space is necessary, please attach a separate page marked Exhibit “C”) 6. The following is a statement as to why the adoption is in the best interest of the adoptive parent, the adoptee, and the public: ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ (If more space is necessary, please attach a separate page marked Exhibit “D”) ______________________________________________________________________________________ Form Approved for Optional Use Shasta County Superior Court LF-016 [rev May 28, 2010] PETITION FOR ADOPTION - ADULT - Family Code §9321 Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com Case Number: IN THE MATTER OF 7. Names and addresses of living birth parents or living children of the adoptee: ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ (If more space is necessary, please attach a separate page marked exhibit “E”) 8. Names of other adults previously adopted by adoptive parent(s) or spouse of adoptive parent: Name of Adopted Adult (s) Date and County Adoption Took Place Adopted by _________________________ __________________ ____________________________ _________________________ __________________ ____________________________ (If more space is necessary, please attach a separate page marked Exhibit “F”) 9. We have entered into and hereby submit a written adoption agreement stating that the parties agree to assume toward each other the legal relationship of parent and child and to have all of the rights and be subject to all of the duties and responsibilities of that relationship. 10. Each of our spouses has consented in writing to this adoption. We hereby submit those written consents. 11. The adoptee’s name after adoption shall be: _______________________________________ Print Name We ask the court to approve the adoption and to declare that the adoptive parent(s) and the adoptee have the legal relationship of parent and child, with all rights and duties of this relationship, including the right of inheritance. 12. I declare under penalty of perjury under the laws of the State of California that the information in this form is true and correct. Date: ______________ ___________________________________ Type or print name Date: ______________ ___________________________ Signature of Adoptive Parent ___________________________________ Type or print name Date: _____________ ___________________________ Signature of Adoptive Parent ___________________________ ___________________________________ Type or print name Signature of Adoptee ______________________________________________________________________________________ Form Approved for Optional Use Shasta County Superior Court LF-016 [rev May 28, 2010] PETITION FOR ADOPTION - ADULT - Family Code §9321 Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com