COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. : STATE OF MINNESOTA COUNTY OF DAKOTA Plaintiff(s) -against- Calendar No. DISTRICT COURT : JUDICIAL SUBPOENA FIRST JUDICIAL DISTRICT : FAMILY DIVISION : IN THE MATTER OF THE PETITION OF : PETITION FOR ADOPTION __________________________________________ and Defendant(s) : ...................................................... _______________________________________ his wife Court File No.: to adopt ______________________________________ D.H.S. No.: THE PEOPLE OF THE to petitioners)NEW YORK STATE OF (name known TO YOUR PETITIONERS Respectfully Requests and Shows to the Court: 1. That they are husband and wife, and were married at _______________________________________ County of GREETINGS: ___________________________________, State of ______________________________________, on the ________________ day of _________________________, _____________, that their full names and ages are: WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before _________________________________ age _______________ and ________________________________ age , the Honorable that they reside at _________________________________________________________ City of at the Court ____________ located at County of __________________________ County of __________________________, State of Minnesota; and for more in room , on the day of , petition.at , o'clock in the noon, and at any recessed than one year immediately preceding the filing of this20 or adjourned date, to testify and give evidence as a witness in this action on the part of the 2. That a ______male child was placed in their home for adoption on _________________________________, by ______________________________________________ a child placing agency duly licensed by the State of Minnesota; and failure tochild haswith thistheir homeis punishable sincecontempt of court and will make you liable to that said comply been in subpoena and custody as a said date. (or) That the Human Services Your Department of _____________________________ County, as agent for the Commissioner of Human Services, the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a State of Minnesota, placed a ______male child in the home of petitioners on ___________________________, result of your failure to comply. and that said child has been in their home and under their custody ever since. (*) Witness, on information and belief, state that said child has no interests in real Justices of the property , one of the estate, personal 3. That the petitioners, Honorable Court fund agreements, at this date: day of County, , 20 or trustin (**) _________________________________________________________. 4. That on information, Petitioners state that the name of said child is (***) ________________________________ (or) unknown, and was born in the County of ________________________, State of _______________________, (Attorney must sign above and type name below) on the ____________ day of ____________________________, ________, and that your petitioners desire that its name be changed to ___________________________________________________________________________. Attorney(s) the 5. That your petitioners have been informed by the placement agency, that all offor pertinent and required information under the Statutes concerning said child herein so placed for adoption, and the natural parents thereto, birthdate and place, is recorded in the placements agencies; Case No.__________________________, and/or, in the files of the Commissioner of Human Services, State of Minnesota, in case No. ________________________. That said placement agency has consented to this adoption. Office and P.O. Address 6. That on information and belief of petitioners, the Commissioner of Human Services, or other appropriate agency, upon receipt of a copy of this petition, together with the required Notice, will, pursuant to M.S.A. Section 259.27, Telephone No.: as amended, transmit to the Court, all required records, reports, and recommendation, together with consent and Facsimile No.: legal documents, as required under M.S.A. Sections 259.21 to 259.32 inclusive. E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. : Calendar No. 7. That the petitioners desire that the relationship of parent and child be established between the petitioners and the child herein, and that it is for the best interest of said child that it be: adopted by said petitioners. JUDICIAL SUBPOENA Plaintiff(s) -againstWHEREFORE, Your Petitioners pray for an order directing the: entry of a decree for adoption of said child by petitioner in accordance with the Statutes in such cases made and provided and that the name of the child be : changed to ____________________________________________________________ and for such other orders as the Court may deem advisable. : Dated:________________________________ Defendant(s) : ...................................................... _____________________________________ _____________________________________ THE PEOPLE OF THE STATE OF NEW YORK Attorney and Address TO _______________________________________ Petitioner _______________________________________ Petitioner STATE OF MINNESOTA ) GREETINGS: )ss VERIFICATION COUNTY OF __________________) WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable at _____________________________________ his wife, Court _________________________________________ andthe being first duly sworn on oath statelocated at have read the foregoing petition subscribed by them, and that they that they County of know the contents thereof, and that the same is true to20 best information and belief. noon, and at any recessed in room , on the day of , their , at o'clock in the or adjourned date, to testify and give evidence as a witness in this action on the part of the Subscribed and sworn to before me this _________ ______________________________________ Day of ________________________, 20________. Petitioner 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 ______________________________________ result Public, ______________________ County Notaryof your failure to comply. Petitioner State of Minnesota My Commission expires________________________ Witness, Honorable , one of the Justices of the Court in County, day of , 20 Note: (Attorney must sign above and type name below) *#2. Is for private agency or Department-strike one not pertinent. **#3. If child has property add “Excepting as stated on Exhibit ‘A’ attached. ***#4. Name may be “Baby Boy ‘Jones’” or “unknown” or full name may be known-use proper fact. Attorney(s) for Office and P.O. Address Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com