FORM # 1 Attorney/Petitioner(s) Name(s): IN THE COURT OF COMMON PLEAS Address: CHESTER COUNTY, PENNSYLVANIA ORPHANS’ COURT DIVISION Phone Number: IN RE: FOREIGN ADOPTION OF ______________________________________________________ ADOPTION NO. _______________________________________ PETITION TO REGISTER FOREIGN ADOPTION DECREE PURSUANT TO 23 Pa.C.S..§2908 1. Petitioner(s), the Adopting Parent(s) of the above-named adopted child, is/are ________________________________________________________________________________________ ________________________________________________________________________________________ 2. Petitioner(s) reside(s) in ________________________________________________ County, Pennsylvania, at ________________________________________________________________________________________ (Street Address) ________________________________________________________________________________________ (City, State, Zip) 3. The full name of the adopted child at birth was __________________________________________________ 4. The full name by which the adopted child is to be known is ________________________________________________________________________________________ 5. The date of birth of the adopted child is ________________________________________________________ 6. The date of the foreign adoption decree is ______________________________________________________ 7. The type of visa issued to the adopted child is ___________________________________________________ 8. The following documents are attached to this Petition: a. Certified copy of child’s birth certificate or other birth identification issued by country of birth; if none, an Affidavit of Parent(s) stating why none is available. b. Certified copy of Decree of Adoption issued by foreign government; if Decree is not in English, an English translation certified by the translator to be correct is attached. c. Copy of adopted child’s United States visa. d. Pennsylvania Department of Health form H105.091 (Vital Records Form) with Parts I and II (and Part III, if applicable) completed. e. Pennsylvania Department of Health Statement of Citizenship and Residence. American LegalNet, Inc. www.FormsWorkflow.com WHEREFORE, Petitioner(s) request(s) that this Court enter a Decree authorizing the registration and docketing of the attached Foreign Adoption Decree with the Clerk of the Orphans' Court and decreeing that ________________________________________________________________________________________ (Birth Name of Adopted Child) shall henceforth be known as _________________________________________________________________ and shall have all the rights of a child and heir of the Petitioner(s). ___________________________________________________ Adopting Parent ___________________________________________________ Adopting Parent American LegalNet, Inc. www.FormsWorkflow.com