CONNECTICUT PROBATE COURTS Petition/Adoption PC-603 REV 7/18 CONFIDENTIAL RECEIVED: Instructions: 1) The sole parent, a statutory parent or a guardian of the person of a minor child who is free for adoption as provided in C.G.S. sections 45a-724 and 45a-725 may use this form to petition for approval of an adoption of the minor child. 2)The petition must be filed in duplicate in the court for the probate district in which the adoptive parentresides or the district where the statutory parent is located. 3)The following documents must be filed with the petition: a) certified long-form birth certificate, b) Adoption Agreement, PC-681, c) Adoption Data Sheet, PC-680, andd) JD-M-164, Affidavit Concerning Children, 4)For more information, see C.G.S. sections 45a-724 et seq. and Rule 40 of the Probate Court Rules ofProcedure. 4)Type or print the form in ink. Probate Court Name District Number In the Matter of (Name and present address) Hereinafter referred to as the minor child. Date of Birth of Minor Child Place of Birth of Minor Child Tribe and Reservation of Minor Child, if an Indian Child as defined by 25 U.S.C. section 1903 (Name and address) Jurisdiction based on: Adoptive parent resides in the probate district. Statutory parent has an office in the probate district. Petitioner (Name, address and telephone number) Sole parent of the minor child Statutory P arent Guardian of the person of the minor child Adoptive Parent (s) (Name, address and telephone number) THE PETITIONER REPRESENTS THAT to the best knowledge and belief: There is no proceeding pending or contemplated in Connecticut or any other state affecting the custody of the minor child. There is a proceeding pending or contemplated in Connecticut or any other state affecting the custody of the minor child, but the proposed adoption will not conflict with or interfere with the other proceeding. (File JD-FM-164, Affidavit Concerning Children, and state the nature of the proceeding in detail below.) American LegalNet, Inc. www.FormsWorkFlow.com CONNECTICUT PROBATE COURTS Petition/Adoption PC-603 REV 7/18 CONFIDENTIAL The minor child is free for adoption pursuant to C.G.S. section 45a-725. The petitioner is the sole parent of the minor child and Has entered into an Adoption Agreement for the adoption of the minor child with the adoptive parent who is the petitioner222s spouse. Has entered into an Adoption Agreement for the adoption of the minor child with the adoptive parent, who is a person who shares parental responsibility for the child with the parent. The petitioner is the statutory parent for the minor child and has entered into an Adoption Agreement for the adoption of the minor child with the adoptive parent(s). The petitioner is a guardian of the person of the minor and has entered into an Adoption Agreement for the adoption of the minor with the adoptive parent(s), one of whom is a blood relative descended from a common ancestor not more than three generations removed from the minor child. The adoption of the minor child by the adoptive parent (s) is in the best interest of the minor child. WHEREFORE, THE PETITIONER REQUESTS that: The court approve the Adoption Agreement submitted with the petition between the petitioner and the adoptive person(s). Change the name of the minor child to: . The representations made in this petition are made under the penalty of false statement. Signature of Petitioner Title, if applicable Type or Print Name Date Consent of Minor Child I, the undersigned minor child, being at least 12 years of age, consent to adoption by the proposed adoptive parent (s). C.G.S. section 45a-724. Signature of Minor Child Duly Acknowledged Before Me Type or Print Name Date Judge, Clerk, Public Notary, Comm. Sup. Ct. American LegalNet, Inc. www.FormsWorkFlow.com CONNECTICUT PROBATE COURTS Confidential Information/Petition/Adoption PC - 603CI NEW 7/18 Confidential Information/ Petition/Adoption PC - 603 CI Probate Court Name District Number In the Matter of , a minor child. The social security numbers of the following persons are required in connection with this proceeding. 1)Adoptive Parent: a.Name Social Security Number 2)Adoptive Parent: a.Name Social Security Number American LegalNet, Inc. www.FormsWorkFlow.com