FCS-500-2016-M Mandatory Form July 2016 1 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, Address, and Telephone No.): ATTORNEY FOR: ATTORNEY BAR #: FOR COURT USE ONLY SUPERIOR COURT OF CALIFORNIA, COUNTY OF TULARE Street Address: County Civic Center South County Justice Center Mailing Address: 211 S. Mooney Blvd. OR 300 E. Olive Ave. City and Zip code: Visalia, CA 93291 Porterville, CA 93257 IN THE MATTER OF THE ADOPTION PETITION OF: (Adopting stepparent/domestic partner) on behalf of: (Minor/s) PETITIO N TO DECLARE MINOR(S) FREE FROM PARENTAL CUSTODY AND CONTROL AND TERMINATE PARENTAL RIGHTS CASE NUMBER: en-CA en-CAPetitioner respectfully represents: en-CA en-CA1. Petitioner, , is an adult person, the stepfather/stepmother of the minor en-CA child/ren , en-CA and seeks to adopt the child/ren on termination of rights of , en-CA to custody and control. Petitioner is the husband/wife of , who is en-CA the mother/father of the minor and who has custody of the minor/s. en-CA2. is/are unmarried minor child/ren who en-CA was/were born and is a/are resident/s of , en-CA Tulare County, California. en-CA3. is the parent who has custody of the child/ren and en-CA resides at , Tulare County, California. en-CA4. is the non-custodial parent of the child/ren who resides en-CA at . en-CA5. The child/ren has/have been left by their father/mother, , en-CA in the care and custody of , without provision for support en-CA since , a period of more than one (1) year, and without communication from him/her with the intent on the part of to abandon the child/ren. American LegalNet, Inc. www.FormsWorkFlow.com FCS-500-2016-M Mandatory Form July 2016 2 IN THE MATTER OF THE ADOPTION PETITION OF (Name of adopting Parent) CASE NUMBER: Wherefore, Petitioner prays for judgment as follows: 1. For an order declaring that the minor child/ren, , is/are free from the custody and control of , and terminating all of his/her rights and responsibilities with regard to the child/ren; 2. For such other and further relief as the court may deem proper. VERIFICATION I have read the foregoing Petition to Declare Minors Free From Parental Custody and Control and Terminate Parental Rights and know the contents thereof; and that the same is true of my own knowledge, except as to the matters which are therein stated upon my information or belief, and as to those matters that I believe them to be true. I certify (or declare) under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Exectued on at , California. (DATE) (PLACE) (SIGNATURE OF PETITIONER) American LegalNet, Inc. www.FormsWorkFlow.com