COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : ADOPTION CHECKLIST : Index No. Calendar No. : Plaintiff(s) Case No. JUDICIAL SUBPOENA ; Adoption -against: Child: _______________________________ : Comments: ________________________________________________________________________ : ___________________________________________________________________________________ Defendant(s) : ...................................................... ___________________________________________________________________________________ Petitioner: Jurisdiction (D.C. Code Ann. § 16-301(b) (2001) (check at least one) THE PEOPLE OF THE STATE OF NEW YORK 1. ___ TO Petitioner was a legal resident of D.C. when petition filed OR Petitioner was an actual resident of D.C. for at least one year immediately preceding filing 2. ___ Child is in the legal custody of CFSA or child-placing agency licensed in DC. GREETINGS: ________________________________ Agency: WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable(D.C. Code Ann. § 16-302 (2001)) (check at least one) at the Court Petitioner Eligibility located at County of in , on day of , 20 , at o'clock in the noon, and at any recessed 1. ___room not married the is or adjourned date, to testify and give evidence as a witness in this action on the part of the 2. ___ is married and spouse is a party in this matter Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to Discretionary Waiver of Investigative Report (D.C. Code Ann. § 16-308 (2001)) the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply. No report is required because 1. 2. Witness, an adult (18 , one of the Justices of the ___ Adoptee is Honorable or older) Court in County, day of , 20 ___ Petitioner is the spouse of a natural parent who consents or is also a Petitioner (Attorney must sign above and type name below) Investigative Report (D.C. Code Ann. § 16-307 (2001) and Super. Ct. Adoption R. 7(d)) (This is only a partial listing of requirements. NOTE: The court may enter a decree after consideration of a report from which some information is missing.) Attorney(s) for Report contains the following representations (all must be checked) 1. Petitioner's allegations are true or inaccuracies are explained. 2. Office and P.O. Address Prospective adoptee is a proper subject for adoption after investigation of adoptee's environment, antecedents, and assets (assets over $3000 to be itemized). 3. Prospective home is suitable. 1 Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. 4. Suitable subsidy agreement (if any) approved. 5. Child residing with Petitioner(s) since___________________ (at least 6 months ago). : JUDICIAL SUBPOENA Plaintiff(s) Three post-placement interviews completed (29 D.C.M.R. 1624.2) -against: 6. : Calendar No. Dates: 1.___________________ 2. ________________ 3. ________________ : 7. 8. Documentation of the agency's contacts with three (3) references (29 D.C.M.R. 1620.5(u) : Agency recommends issuing adoption decree Defendant(s) : ...................................................... Final Interlocutory 9. _______ Signature of social worker and social worker supervisor and statement that report is true and THE PEOPLE OF THE STATE OF NEW YORK correct TO 10. _______ CFSA Director Approval Clearances (D.C. Code Ann. § 4-1305.01 et seq. and 29 D.C.M.R. 16205(q),(r)) GREETINGS: WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before P1 P2 OTHER , the Honorable at the Court (Date) (Date) (Date) located at County of in room ________ the , on ________ ofChild Prection Register check withinin theyear for all and at any recessed day , 20 , at o'clock one noon, adults in 1. ________ or adjourned date, to testify and give evidence as a and from all states where the adults have lived in the household witness in this action on the part of the last then years 2. ________ ________ ________ Criminal history check within one year (everywhere but Maryland) Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to for all adults in household the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result 3. ________ of your failure to comply. ________ ________ FBI clearance within two years (everywhere but Maryland) for all adults in household Witness, Honorable , one of the Justices of the 4. ________ in ________ County, ________ day of Medical clearance within one year for every household member Court , 20 5. ________ ________ ________ Military registry check, if applicable (Attorney must sign above and type name below) Attorney(s) for Office and P.O. Address 2 Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. : Calendar No. Interstate Compact on Placement of Children Compliance (ICPC) (D.C. Code Ann. §§ 4-1421 to 4-1424 (2001 & Supp. 2003)) : JUDICIAL SUBPOENA Plaintiff(s) 1. Petitioner proposes sending child from to for purpose of -against: adoption AND child was placed after September 20, 1989, AND Agency has provided a notice of compliance with the ICPC : 2. No compliance is required because (check one or both) : a. Petitioner does not propose sending child from one jurisdiction to another Defendant(s) : . . . . . . . . . . . . . . . . jurisdiction. for.purpose .of .adoption. AND/OR ......... .. ....... . ....... ....... b. Child was placed on/before September 20, 1989 THE Adoptees THE STATE OF NEW YORK Consents forPEOPLE OFUnder Age 18 (D.C. Code Ann. § 16-304) TO ___ A. Signed and acknowledged consent of adoptee 14+ yrs (b)(1) 2. BM BF GREETINGS: ___ ___ Consent issue resolved (one category below must be checked for WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before each parent) , the Honorable at the Court located at County of ___ ___ Signed and acknowledged consent (b)(2) in room , on the day of , 20 , at o'clock in the noon, and at any recessed or adjourned date, to testify and give evidencerights per D.C.this action on§ 4-1406 the ___ ___ Relinquishment of as a witness in Code Ann. the part of 3. ___ B. 1. 4. 5. 6. ___ Parental rights terminated (OR "released") (b)(2)(D) AND Consent of CFSA or the Agency (b)(2)(E) Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the ___ party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a ___ Deceased (b)(2)(B) result of your failure to comply. ___ ___ Signed and acknowledged consent of court-appointed guardian (not GAL) Witness, Honorable , one of the Justices of the ___ in ___ Consent waived by the court20 Court County, day of , (Attorney must sign above and type name below) Attorney(s) for Office and P.O. Address 3 Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. Contents of Final Decree (D.C. Code § 16-309; Super. Ct. Adoption R. 7(f)) (ALL MUST BE CHECKED) : Calendar No. 1. ______ Jurisdictional statement Plaintiff(s) : JUDICIAL SUBPOENA 2 Full name(s) of petitioner(s) -against- 3. Full name of adoptee and adoptee's date and place of birth : 4. 5. : New name of adoptee (if requested) or statement that name will remain otherwise : unchanged Defendant(s) : . . . . . . . . . . . .Adoptee .is .physically. and .mentally .suitable. for. adoption by the petitioner ....... . ........ ... ....... ...... .. . 6. Petitioner(s) is/are fit and able to give adoptee a proper home and education 7. THE PEOPLEAdoption STATE in the best interests of the adoptee OF THE will be OF NEW YORK 8. TO 9. Vital Records Form completed (D.C. Code Ann. § 7-209 (Supp. 2003)) Adoptee has continuously resided with petitioner(s) since GREETINGS: 11. 13. ______ WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Final Decree establishes the relationship of natural parent and natural child between , the Honorable adopter and adoptee for all purposes. at the Court located at County of ______ Compliance with day of requirements of Interstate Compact on the Placement of Children recessed in room , on the , 20 , at o'clock in the noon, and at any or adjourned date, to testify and give evidence as a witness in this action on the part of the ______ Clerk to provide certified copies 14. ______ 12. 15. Copies to list: petitioner, petitioner's counsel, and William S. Johnson, LICSW YourAdoption Resources Program, Child and Family Services Agency and will make you liable to failure to comply with this subpoena is punishable as a contempt of court the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure tois (check one) Decree comply. Final (residence with petitioner must be 6 months ,or more) Justices of the Witness, Honorable one of the Court in County, day of , 20 Interlocutory (decree includes language about when it will automatically become final) (Attorney must sign above and type name below) Contents of Notice of Issuance of Final Decree (Super. Ct. Adoption R. 52) 1. 2. Attorney(s) for Petitioner's intials only ______ Copies to list: petitioner's counsel, mother's counsel, father's counsel, GAL, social worker, William Johnson of CFSA, and neglect judge, if different from Office "contesting" parties). assigned judge. (Note: rules only require notice to and P.O. Address 4 Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com