CONNECTICUT PROBATE COURTS Petition/Validation of Foreign Adoption PC - 604 REV. 7/18 CONFIDENTIAL Petition/ Validation of Foreign Adoption PC - 604 Page 1 of 2 RECEIVED : Instructions: 1) An adoptive parent or a duly authorized officer of a child-placing agency may use this form to petition the court to validate an adoption of a minor child born outside of the United States or its territories when the adoption was finalized in a jurisdiction other than the United States or its territories, and the minor child is unable to obtain United States citizenship because the adoptive parents did not personally see and observe the child prior to or during the adoption proceedings. 2)The petition must be filed in the probate district in which the petitioner resides or in the district in whichan office of the child-placing agency is located. The petition shall be accompanied by an authenticated and exemplified copy of the adoption unless the court waives the requirement for good cause. A certified or authenticated copy of the birth certificate for the minor child should also be submitted. 3)For more information, see C.G.S. section 45a-730. 4)Type or print the form in ink. Probate Court Name District Number In the Matter of Hereinafter referred to as the minor child. M F Date of Birth of Minor Child Place of Birth of Minor Child Petitioner (Name, address and telephone number) Name and Address of each Adoptive Parent (Name, including maiden name of adoptive mother, if applicable, address, and telephone number) THE PETITIONER REPRESENTS THAT: The petitioner resides in the district or an office of the child placing agency is located in the district. The minor child was born, and the adoption occurred, outside of the United States and its territories. The United States Citizenship and Immigration Services will not naturalize the minor child because one or both of the adoptive parents did not personally see or observe the minor child before or during the adoption proceedings. An authenticated and exemplified copy of the adoption is submitted with this petition. The information contained in the adoption documents are true and complete to the best of the petitioner222s knowledge and belief. An authenticated and exemplified copy of the adoption is not submitted with the petition for the following reasons: (Continue on next page if more space is needed.) American LegalNet, Inc. www.FormsWorkFlow.com CONNECTICUT PROBATE COURTS Petition/Validation of Foreign Adoption PC - 604 REV. 7/18 CONFIDENTIAL Petition/ Validation of Foreign Adoption PC - 604 Page 2 of 2 There is a proceeding is no proceeding pending or contemplated in Connecticut or any other state affecting the custody of the minor child. (If a proceeding is pending or contemplated, file form JD-FM-164, Affidavit Concerning Children.) THE PETITITIONER REQUESTS THAT: The court validate the foreign adoption of the minor child by the adoptive parents. The representations made in this petition are made under the penalty of false statement. Signature of Petitioner Title Type or Print Name Date Signature of Petitioner Title Type or Print Name Date American LegalNet, Inc. www.FormsWorkFlow.com