Form 150 (Rev. 10/11) The Family Court of the State of Delaware In and For New Castle Kent Sussex County PETITION FOR ADOPTION In the Matter of: Petitioner Name Street Address P.O. Box Number City/State/Zip Code Home Phone Relationship to Child(ren) Work Phone 2nd Petitioner (if any) Name Street Address P.O. Box Number City/State/Zip Code Home Phone Relationship to Child(ren) Work Phone File Number Marital Status: Attorney Name Married Single Marital Status: Attorney Name Married Single Interpreter needed? Language Yes No Interpreter needed? Language Yes No IN THE INTEREST OF THE FOLLOWING CHILD(REN): (Complete the table below for each child whom petitioner seeks to adopt. Attach additional sheets if necessary.) Child's Name Petitioner's Relationship to Child Child's Date of Birth Child's Place of Birth (City, State) Child's Gender Male Male Male Female Female Female 1. Name of the person, persons, or organization legally qualified to consent to the adoption: Date of Child's Placement in Adoptive Home If Child is Being Adopted by Stepparent; Date of Marriage between stepparent and natural parent OR... Person or Organization Address 2. The child(ren) will assume the following name(s) upon adoption: 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com Form 150 (Rev. 10/11) 3. Is child being brought into this State from another state or country for adoption in this state? Yes No If YES, I have attached proof of compliance with the Interstate Compact for the Placement of Children in the form of written approval from the Delaware Division of Services for Children, Youth and Family Services. 4. I have attached the birth certificate of the child, not the certificate of live birth. 5. I have attached the mandatory Affidavit of Expenses (Form 156). 6. Is the child being adopted 14 years of age or over? Yes No If YES, I have attached an Affidavit of Consent of Child 14 years of Age or Older (Form 159). 7. Has the person(s) legally qualified to consent to the adoption consented to this Petition for Adoption? If YES, I have attached the following: Affidavit of Consent of Natural Parent whose Spouse is Petitioning for Adoption (Form 158) A certified copy of the marriage certificate between the natural parent and step parent Consent to Termination and Transfer of Parental Rights (Form 140) 8. I ( do do not) wish to request a hearing/ceremony if the adoption is granted. I understand that having a hearing/ceremony is solely within the discretion of the hearing officer. WHEREFORE, Petitioner(s) seeks to adopt the above-named minor child(ren). Petitioner/Petitioner's Attorney Petitioner 2, if any Date Sworn to and subscribed before me this day of Date Sworn to and subscribed before me this day of Notary Public or Clerk of Court AFFIDAVIT OF TRUTH I, correct to the best of my knowledge. Notary Public or Clerk of Court , state the information in this Petition for Adoption is true and Affiant Sworn to subscribed before me this ______ day of ______________________, _________ Notary Public 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com