COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. : DISTRICT COURT, COUNTY OF _________________________________, STATE OF MINNESOTA Calendar No. : In the Matter of the Welfare of __________________________________________, a Child, and the Petition JUDICIAL SUBPOENA Plaintiff(s) -against: Of _____________________________ and ____________________________, his Wife, to Adopt said Child. : PETITION FOR ADOPTION : Defendant(s) Your petitioners respectfully represent and show to the court: : ...................................................... 1. That they are husband and wife and were married on _______________________________________ at _______________________________, that their full names are _________________________________ THE PEOPLE OF THE STATE OF NEW YORK respective ages are _________ and ________ years; that and _____________________________; that their their place of residence is ___________________________________________________ in the County of TO ____________________________, State of Minnesota; that they have resided in the State of Minnesota for more than one year immediately preceding the filing of this petition; that they are related to the child to be adopted as ________________________________________ which is a relationship by blood or marriage GREETINGS: within the third degree***; WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before 2.theThat they acquired physical custody of __________________________________________________ from , Honorable at the Court located at County of ______________________________________ on _____________________________ and that said child in room , on the day of , 20 , at o'clock in the noon, and at any recessed or has lived in theirto testify andsaid date. adjourned date, home since give evidence as a witness in this action on the part of the 3. That said child was born in the _________________________ of __________________________ County of ________________________, State of ___________________________ on _____________________. Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to 4. That the mother of said child is ___________________________________________ and that the father is the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a ___________________________; that the guardian of said child is _______________________________. result of your failure to comply. 5. That the actual name of the child and any known aliases are _____________________________________ Witness, Honorable , one of the Justices of the _____________________________________________________________________________________. Court in County, day of , 20 6. That your petitioners desire to have the name of the child changed to ______________________________ _____________________________________________________________________________________. (Attorney must sign above and type name below) 7. That the description and value of any real or personal property owned by said child are as follows: Attorney(s) for 8. That your petitioners desire that the relationship of parents and child andestablished between petitioners and Office be P.O. Address the child, and that it is to the best interest of the child for the child to be adopted by them. 9. That the parent(s) (guardian)(agency)(Commissioner of Human Services) have consented to the adoption as Telephone No.: hereinafter shown; or that no consent is required because _______________________________________. Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. : WHEREFORE, your petitioners pray this honorable Court for leave to Calendar their own child, the said adopt as No. _____________________________________________________ in accordance with the statute in such case : JUDICIAL SUBPOENA Plaintiff(s) made and provided, and that the name of said child be changed to __________________________________ -against: _________________________________________ and that such other orders may be made as law and justice : may require. : ____________________________________ _____________________________________ Attorney for Petitioners Petitioner Defendant(s) : ................................... Address______________________________. . . . . . . . . . . . . . . . . . . _____________________________________ _____________________________________ Petitioner THE PEOPLE OF THE STATE OF NEW YORK STATE OF MINNESOTA TO COUNTY OF ____________________ _______________________________________________ and ____________________________________, his GREETINGS: wife, being first duly sworn, on oath say that they have read the within and foregoing petition subscribed by them, and know the contents thereof and that the same is true to their best information and belief. WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable at the Court ____________________________________ located at County of Petitioner in room , on the day of , 20 , at o'clock in the noon, and at any recessed or adjourned date, to testify and give evidence as a witness in this action on the part of the ____________________________________ Petitioner Subscribed and sworn to before me this ________ day of ___________________________, _______. 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 of your failure to comply. ____________________________________ Notary Public ___________ County, one of the Justices of the Witness, Honorable , State of Minnesota My Commission Expires ________________ Court in County, day of , 20 (Attorney must sign above and type name below) ***NOTE: Parent, stepparent, brother, sister, aunt, uncle, grandparent, grandchild, niece, nephew, great grandparent, great grandchild, are within the third degree. Attorney(s) for Office and P.O. Address Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. : DISTRICT COURT, COUNTY OF _________________________________, STATE OF MINNESOTA Calendar No. : CONSENT OF MOTHER TO ADOPTION AND WAIVER OF NOTICE OF SUBPOENA JUDICIAL HEARING Plaintiff(s) -against: The undersigned, being the mother of the child mentioned in the foregoing petition, after being fully advised of all the premises herein, and with a view to the future welfare of the child, hereby consents to the : adoption of the said ___________________________________ by _______________________________ and __________________________________ , his wife, petitioners herein, and hereby waives notice of hearing : upon the foregoing petition. A parent’s consent to the adoption mayDefendant(s) for any reason within 10 working days after the be withdrawn : consent .is .executed. and .acknowledged . . . written. notification .to .the .Commissioner of Human Services or his . . . . . . . . . . . . . . . . . . . . . . . . . . by . . . . . . . . . . . . . . . . . agent, thereafter consent shall be irrevocable, M.S. 259.24, Subd. 6a. THIS AGENCY WILL SUBMIT YOUR CONSENT TO ADOPTION TO THE COURT. THE CONSENT ITSELF DOES NOT TERMINATE YOUR PARENTAL RIGHTS. PARENTAL RIGHTS TO A CHILD THE PEOPLE OF THE ONLY OF AN ADOPTION DECREE OR BY A COURT ORDER MAY BE TERMINATEDSTATE BY NEW YORK TERMINATING PARENTAL RIGHTS. UNLESS THE CHILD IS ADOPTED OR YOUR PARENTAL RIGHTS ARE TERMINATED, YOU MAY BE ASKED TO SUPPORT THE CHILD. TO In Presence of: ___________________________________ GREETINGS: (Witness) WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before ___________________________________ ______________________________________ , the Honorable at the Court (Witness) located at County of in room , on the day of , 20 , at o'clock in the noon, and at any recessed or adjourned date, to testify and give evidence as a witness in this action on the part of the STATE OF MINNESOTA COUNTY OF ____________________ 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 andme personallysustained as a On this ______________ day of _________________________, _______, before all damages result of your failure to comply. appeared ________________________ , to me known to be the person described in, and who executed, the foregoing consent and waiver, and acknowledged that she executed the same as her free act and deed. Witness, Honorable , one of the Justices of the ____________________________________ Court in County, day of , 20 Notary Public ___________ County, State of Minnesota ______________________________________ My Commission Expires ________________ (Attorney must sign above and type name below) Commissioner of Human Services, his agent or Representative of Licensed Child-Placing Agency STATE OF MINNESOTA Attorney(s) for COUNTY OF ____________________ On this ___________ day of ______________________, _____, before me personally appeared __________________________________, to me known to be theOffice and P.O. of Human Services, his agent, Commissioner Address or a representative of a Licensed Child-Placing Agency and known to me to be personally present when ________________________________ executed the foregoing consent. Telephone No.: ____________________________________ Facsimile No.: Notary Public E-Mail Address: ___________ County, State of Minnesota Mobile Expires My CommissionTel. No.: ________________ American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. : DISTRICT COURT, COUNTY OF _________________________________, STATE OF MINNESOTA Calendar No. CONSENT OF FATHER TO ADOPTION AND WAIVER: OF NOTICE OF HEARING JUDICIAL SUBPOENA Plaintiff(s) -against: The undersigned, being the father of the child mentioned in the foregoing petition, after being fully advised of all the premises herein, and with a view to the future welfare of the child, hereby consents to the : adoption of the said ___________________________________ by _______________________________ and __________________________________ , his wife, petitioners herein, and hereby waives notice of hearing : upon the foregoing petition. A parent’s consent to the adoption mayDefendant(s) for any reason within 10 working days after the be withdrawn : consent .is .executed. and .acknowledged . . . written. notification .to .the .Commissioner of Human Services or his . . . . . . . . . . . . . . . . . . . . . . . . . . by . . . . . . . . . . . . . . . . . agent, thereafter consent shall be irrevocable, M.S. 259.24, Subd. 6a. THIS AGENCY WILL SUBMIT YOUR CONSENT TO ADOPTION TO THE COURT. THE CONSENT ITSELF DOES NOT TERMINATE YOUR PARENTAL RIGHTS. PARENTAL RIGHTS TO A CHILD THE PEOPLE OF THE ONLY OF AN ADOPTION DECREE OR BY A COURT ORDER MAY BE TERMINATEDSTATE BY NEW YORK TERMINATING PARENTAL RIGHTS. UNLESS THE CHILD IS ADOPTED OR YOUR PARENTAL RIGHTS ARE TERMINATED, YOU MAY BE ASKED TO SUPPORT THE CHILD. TO In Presence of: ___________________________________ GREETINGS: (Witness) WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before ___________________________________ ______________________________________ , the Honorable at the Court (Witness) located at County of in room , on the day of , 20 , at o'clock in the noon, and at any recessed or adjourned date, to testify and give evidence as a witness in this action on the part of the STATE OF MINNESOTA COUNTY OF ____________________ 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 andme personallysustained as a On this ______________ day of _________________________, _______, before all damages result of your failure to comply. appeared ________________________ , to me known to be the person described in, and who executed, the foregoing consent and waiver, and acknowledged that he executed the same as his free act and deed. Witness, Honorable , one of the Justices of the ____________________________________ Court in County, day of , 20 Notary Public ___________ County, State of Minnesota ______________________________________ My Commission Expires ________________ (Attorney must sign above and type name below) Commissioner of Human Services, his agent or Representative of Licensed Child-Placing Agency STATE OF MINNESOTA Attorney(s) for COUNTY OF ____________________ On this ___________ day of ______________________, _____, before me personally appeared __________________________________, to me known to be theOffice and P.O. of Human Services, his agent, Commissioner Address or a representative of a Licensed Child-Placing Agency and known to me to be personally present when ________________________________ executed the foregoing consent. Telephone No.: ____________________________________ Facsimile No.: Notary Public E-Mail Address: ___________ County, State of Minnesota Mobile Expires My CommissionTel. No.: ________________ American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. : DISTRICT COURT, COUNTY OF _________________________________, STATE OF MINNESOTA Calendar No. : CONSENT OF GUARDIAN TO ADOPTION AND WAIVER OF NOTICE OF HEARING JUDICIAL SUBPOENA Plaintiff(s) -against: The undersigned, being the duly appointed, qualified, and acting guardian of the child mentioned in the foregoing petition, after being fully advised of all the premises herein, and with a view to the future welfare of : the child, hereby consents to the adoption of the said ___________________________________ by _______________________________ and __________________________________ , his wife, petitioners : herein, and hereby waives notice of hearing upon the foregoing petition. A parent’s consent to the adoption mayDefendant(s) for any reason within 10 working days after the be withdrawn : consent .is .executed. and .acknowledged . . . written. notification .to .the .Commissioner of Human Services or his . . . . . . . . . . . . . . . . . . . . . . . . . . by . . . . . . . . . . . . . . . . . agent, thereafter consent shall be irrevocable, M.S. 259.24, Subd. 6a. THIS AGENCY WILL SUBMIT YOUR CONSENT TO ADOPTION TO THE COURT. THE CONSENT ITSELF DOES NOT TERMINATE YOUR PARENTAL RIGHTS. PARENTAL RIGHTS TO A CHILD THE PEOPLE OF THE ONLY OF AN ADOPTION DECREE OR BY A COURT ORDER MAY BE TERMINATEDSTATE BY NEW YORK TERMINATING PARENTAL RIGHTS. UNLESS THE CHILD IS ADOPTED OR YOUR PARENTAL RIGHTS ARE TERMINATED, YOU MAY BE ASKED TO SUPPORT THE CHILD. TO In Presence of: ___________________________________ GREETINGS: (Witness) WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before ___________________________________ ______________________________________ , the Honorable at the Court (Witness) located at County of in room , on the day of , 20 , at o'clock in the noon, and at any recessed or adjourned date, to testify and give evidence as a witness in this action on the part of the STATE OF MINNESOTA COUNTY OF ____________________ 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 andme personallysustained as a On this ______________ day of _________________________, _______, before all damages result of your failure to comply. appeared ________________________ , to me known to be the person described in, and who executed, the foregoing consent and waiver, and acknowledged that ___he executed the same as h___ free act and deed. Witness, Honorable , one of the Justices of the ____________________________________ Court in County, day of , 20 Notary Public ___________ County, State of Minnesota ______________________________________ My Commission Expires ________________ (Attorney must sign above and type name below) Commissioner of Human Services, his agent or Representative of Licensed Child-Placing Agency STATE OF MINNESOTA Attorney(s) for COUNTY OF ____________________ On this ___________ day of ______________________, _____, before me personally appeared __________________________________, to me known to be theOffice and P.O. of Human Services, his agent, Commissioner Address or a representative of a Licensed Child-Placing Agency and known to me to be personally present when ________________________________ executed the foregoing consent. Telephone No.: ____________________________________ Facsimile No.: Notary Public E-Mail Address: ___________ County, State of Minnesota Mobile Expires My CommissionTel. No.: ________________ American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : : Index No. Calendar No. : DISTRICT COURT, COUNTY OF _______________________________, STATE OF MINNESOTA JUDICIAL SUBPOENA Plaintiff(s) -against: CONSENT OF CHILD OVER FOURTEEN YEARS OF AGE : The undersigned, being the child mentioned in the foregoing petition, hereby consents that (s)he be adopted by _______________________________ and __________________________________, his wife. : Defendant(s) : In Presence. of: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ........ .. ___________________________________ (Witness) THE PEOPLE OF THE STATE OF NEW YORK ___________________________________ (Witness) TO ______________________________________ STATE OF MINNESOTA GREETINGS: COUNTY OF ____________________ WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before On this _______, before me personally , the Honorable ______________ day of _________________________,Court at the appeared of located me County ________________________ , to at known to be the person described in, and who executed the foregoing consent, and acknowledged that ___he executed the at in room , on the day of , 20 , same as h___ free act and deed. and at any recessed o'clock in the noon, or adjourned date, to testify and give evidence as a witness in this action on the part of the ____________________________________ Notary Public ___________ County, State of Minnesota ______________________________________ My Commission Expires ________________ Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to Commissioner whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a the party on of Human Services, his agent or Representative of Licensed Child-Placing Agency result of your failure to comply. STATE OFWitness, Honorable MINNESOTA Court in County, day of COUNTY OF ____________________ , one of the Justices of the , 20 On this ___________ day of ______________________, _____, before me personally appeared __________________________________, to me known to be the(Attorney must sign of Human Services, his agent, Commissioner above and type name below) or a representative of a Licensed Child-Placing Agency and known to me to be personally present when ________________________________ executed the foregoing consent. Attorney(s) for ____________________________________ Notary Public ___________ County, State of Minnesota My Commission Expires ________________ Office and P.O. Address Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com