STATE OF ILLINOIS) )SS COUNTY OF WILL ) IN THE CIRCUIT COURT OF THE TWELFTH JUDICIAL CIRCUIT WILL COUNTY, ILLINOIS _____________________________________________ _____________________________________________ Petitioners VS. _____________________________________________ _____________________________________________ Defendants CASE NO.________________________ PETITION FOR ADOPTION Now come petitioners herein and allege as follows: (a) The full name__ of the petitioner__ and, if minor__, __h__ respective age __ are as follows: Name___________________________________________________________________ Age___________ Name___________________________________________________________________Age____________ (b) The place of residence of petitioner__ and the length of residence in Illinois (for each) immediately preceding the filing of the within petition is as follows:__________________________________ Place_____________________________________________________________Length________________ Place_____________________________________________________________Length________________ (c) The petitioner__ acquired/intend__ to acquire custody of said child from_________________ _____________________________________whose address is_____________________________________ _________________________________________________________on______________________, 20___. (Strike out paragraph in case of related child or adult) (d) (e) The name, place and date of birth and sex of the child sought to be adopted is as follows: The relationship, if any, of the child to each petitioner is as follows:____________________ _______________________________________________________________________________________ _______________________________________________________________________________________ (f) The names of the parents of the child, place of residence and whether minor or adult are as follows: Father___________________________________ Age_______ Residence____________________________ Mother__________________________________ Age_______ Residence_____________________________ Neither of the parents are under any legal disability except:__________________________________ _______________________________________________________________________________________ (1) The rights of the parents have been terminated by_____________________________, a court of competent jurisdiction. (2) The child has been surrendered to the following agency:________________________ ______________________________________________________________________________________ 2000 © American LegalNet, Inc. (3) The parent__, namely___________________________________________________ ha__ have been served with the notice provided in Section 12a of this Act and___________________________ __________________________________________________ha___ filed______________________________ (g) The child has no living parent. The legal guardian of the child is_____________________________ who was appointed by_____________________________________________________________________________ (h) The child has no living parent and no legal guardian is known. The name of a near relative is_______________________________ Relationship_____________________ Address_________________________ (i) The name to be given the child (adult) is_________________________________________________ (j) (1) That____________________________________________, being the person/agency having authority to do so, ha__consented/indicated a willingness to consent/to the adoption of the child by the petitioner__. (2) That_____________________________________________, has authority to consent to the adoption of the child by petitioner__, is an/are unfit person__ for the following reason__:________________________ ______________________________________________________________________________________________ (k) Orders, judgments or decrees have been entered affecting: (1) The adoption or custody of the child as follows:____________________________________ ______________________________________________________________________________________________ (2) The adoptive, custodial or parental rights of either petitioner as follows, including the prior denial of any petition for adoption pertaining to such child, or to the petitioners, or either of them:_____________ ______________________________________________________________________________________________ (3) Additional allegation required by the facts of this particular case:______________________ ______________________________________________________________________________________________ WHEREFORE petitioner__ therefore pray__ that the above-named__________________________________ ______________________________________________________________________________________________ may be made defendant__ to this petition, and that a summons may issue for them and each of them, returnable according to law, and that they and each of them be required to answer this petition as is by statute provided. And your petitioner__ further pray__ that the court will, on the final hearing of this petition, ORDER, ADJUDGE and DECREE that the said_____________________shall, to all legal intents and purposes, be the child of your petitioner__, and that the name of said child shall thereafter be_________________________________________ ______________________________________________________________________________________________ And that this Honorable Court will make such other and further orders in the premises as may be in accordance with law. _______________________________________ _______________________________________ (Petitioner__) STATE OF ILLINOIS ) )SS COUNTY OF WILL ) _______________________________________________________________being first duly sworn upon oath depose __ and say__ that__ he__ha__read and signed the foregoing petition and that the contents thereof are true and correct. ______________________________________ NAME_____________________________________________ Attorney for_________________________________________ ______________________________________ ARDC#____________________________________________ Signed and sworn to before me _______________________________, 20____ Address____________________________________________ City_______________________________________________ Telephone__________________________________________ ______________________________________ 2000 © American LegalNet, Inc.