D.R.L. 247109, et seq. Adoption Form 29a (Petition for Adult Adoption) 3/2018 FAMILY COURT OF THE STATE OF NEW YORK COUNTY OF In the Matter of the Adoption of Docket No. PETITION FOR ADULT ADOPTION An Adult, The Petitioner(s) respectfully allege(s) to this Court that: 1. Petitioning adoptive parent [specify name] : resides at [specify address, unless an order of address confidentiality has been obtained pursuant to F . C.A. 247154 - b]: a. Petitioner is of full age, having been born on [specify date of birth]: b. Petitioner is unmarried; or married to specify name of spouse]: and living together; or living separate and apart pursuant to a decree or J udgment of separation or pursuant to a separation agreement subscribed by the parties and acknowledged or proved in the form r equired to entitle a deed to be recorded; or living separate and apart for at least three years prior to commencement of the proceeding. 2. [Applicable if two petitioners]: Petitioning adoptive parent [specify name]: resides at [specify address, unless an order of address confidentiality has been obtained pursuant to F,C.A. 247 154 - b]: a. Petitioner is of full age, having been born on [specify date of birth]: b. Petitioner is unmarried; or married to specify name of spouse]: and living together; or living separate and apart pursuant to a decree or judgment of separation or pursuant to a separation agreement subscribed by the parties and acknowledged or proved in the form required to entitle a deed to be recorded; or living separate and apart for at least three years prior to commencement of the proceeding. 3. [Applicable if Adoptee is the Petitioner]: Petitioner - adoptee [specify name]: was born on [specify date of birth]: and resides at [specify address, unless an order of address confidentiality has been obtained pursuant to F,C.A. 247154 - b]: (A certified copy of the 4. Upon information and belie p arent(s) Parent #1: Parent #2: American LegalNet, Inc. www.FormsWorkFlow.com Adoption Form 29a Page 2 5. The adoptee is seeki ng to change her/his name to [specify]: is not seeking a name change. 6. Neither the adoptive parent nor the adoptee has been the subject of a proceeding for a Guardian under Article 81 of the Mental Hygiene Law or und er Article 17 - Procedure Act. 7. If the adoptee is not a petitioner, his or her consent is attached. WHEREFORE, the Petitioner(s) request(s) an order granting the adoption of [specify Adoptee]: by t he Petitioner(s) and directing that such adoptee shall be treated in all respects as the child of the Petitioner(s) and [check box if applicable]: directing that the name of the adoptee be changed and henceforth be known by the name of [specify name]: together with such other and further relief as may be just and proper. Dated: , . / Adoptive Parent: typed or printed name / signature / Adoptive Parent: typed or printed name / signature / Adoptive child: ty ped or printed name / s ignature / Attorney, if any: typed or printed name / signature Attorney's Address and Telephone Number V ERIFICATION STATE OF NEW YORK ) ) :ss.: COUNTY OF ) , being duly sworn, says that (he)(she)(they)(is)(are) the Pet itioner(s) in the above - named proceeding and that the foregoing petition is true to (his)(her)(their) own knowledge, except as to matters wherein stated to be alleged on information and belief and as to those matters (he)(she)(they) believe(s) it to be tru e. Petitioner Petitioner Petitioner Sworn to before me on , Notary Public Commission Expires: (Affix Notary Stamp or Seal) American LegalNet, Inc. www.FormsWorkFlow.com