Petition/Determination of Age and Date of Birth of Adopted Person Born Outside of the Country PC-604A NEW 7/15 CONNECTICUT PROBATE COURTS RECORDED (CONFIDENTIAL) RECEIVED: Instructions: 1) An adoptive parent who resides in this state and adopted a person born outside of the country, or the adopted person if over the age of eighteen, may use this form to petition for a determination of the biological age and date of birth of the adopted person. 2) The petition should be filed in the court for the probate district in which the adopted person resides. 3) The petitioner shall also file certified copies of the certification of birth registration, certificate of foreign birth, or, if not issued, other adoption record identifying the name and date of birth of the adopted person as of the date of adoption. The petitioner may present medical or other evidence relevant to the issue of the biological age and date of birth of the adopted person at the hearing on the petition. 4) For more information, see C.G.S. section 7-54 (b). 5) Type or print the form in ink. Use Second Sheet, PC-180, or an additional sheet, if more space is needed. District Number Adopted Person's Address and Telephone Number Probate Court Name In the Matter of (List name as appears on document filed as instructed in No. 3 above.) Hereinafter referred to as the adopted person. Petitioner (List the name of each petitioner and, if not the adopted person, list each address and telephone number.) Adopted Person's Date and Place of Birth (List information as it appears on the document filed as instructed in No. 3 above.) Adoptive Parent Adopted Person Other Persons to Whom Notice Should be Given: (List name and address, including the name and address of any adoptive parent who is not the petitioner. Identify relationship to the adopted person.) Petition/Determination of Age and Date of Birth of Adopted Person Born Outside of the Country PC-604A Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com Petition/Determination of Age and Date of Birth of Adopted Person Born Outside of the Country PC-604A NEW 7/15 CONNECTICUT PROBATE COURTS RECORDED (CONFIDENTIAL) THE PETITIONER REPRESENTS THAT: 1) The adopted person was born outside of the country. 2) The date of birth of the adopted person is not accurately reflected in the adoption records and other records of birth, as evidenced by: 3) The correct age and date of birth of the adopted person is believed to be:___________________________________. WHEREFORE, the petitioner (s) request that the court determine the correct age and date of birth of the adopted person. The representations made in this petition are made under the penalty of false statement. Signature of Petitioner Title Print or Type Name Date Signature of Petitioner Title Print or Type Name Date Petition/Determination of Age and Date of Birth of Adopted Person Born Outside of the Country PC-604A Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com