IN THE COURT OF COMMON PLEAS ___________________ COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION (FAMILY COURT DIVISION in Philadelphia County) IN RE: FOREIGN ADOPTION OF __________________ FILE 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) Pennsylvania, at in ________________________ County, (Street Address) (City, State, Zip) 3. Has any other court in this Commonwealth or in any other state reviewed, registered, finalized or otherwise assumed jurisdiction over the foreign adoption decree being registered here: (circle one) Yes No If yes, please provide the name of the court, the state and county, what was previously presented to the court and the resulting decision from the court: (Attach all court decrees). American LegalNet, Inc. www.FormsWorkFlow.com 4. The full name of the adopted child at birth as listed on the foreign birth certificate, if available, was ____. 5. The full name of the adopted child as written on the foreign adoption decree is 6. The full name of the adopted child as he or she is to be known from this time forward is 7. The date of birth of the adopted child is . 8. The date of the foreign adoption decree is . 9. The type of United States visa issued to the adopted child is: (circle one) 10. IR-2, IR-3, IH-3, IR-4, IH-4 The following documents are attached to this Petition: a. 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. 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. c. Copy of adopted child’s United States visa. d. Pennsylvania Department of Health, Division of Vital Records Form No. HD01273F, Certificate of Adoption of a Foreign-Born Child with Parts 1 and 2 (and Part 3, if applicable) completed. e. Pennsylvania Department of Health, Division of Vital Records Form No. HD01275F, Statement of Citizenship and Residency. f. Copy of U.S. Government Form N-560, Certificate of Citizenship, and/or a copy of the child’s United States passport, if either or both documents are available. 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 appropriate Court and decreeing that ___________________________________ shall henceforth be known as (Name of child as written on Foreign Adoption Decree) ______________________________________________ and shall have all the (Child’s name from this time forward) rights of a child and heir of the Petitioner(s). Signature of Adopting Parent1 Signature of Adopting Parent _____________________________ Daytime telephone no. for Adopting Parent(s) 1 When there are two adopting parents, both must sign. American LegalNet, Inc. www.FormsWorkFlow.com VERIFICATION TO PETITION TO REGISTER FOREIGN ADOPTION DECREE PURSUANT TO 23 Pa. C.S. § 2908 I/We, ______________, verify that I/we am/are the Petitioner(s) named in the foregoing Petition, that I/we have read and understand the information set forth in the Instructions to the Petition to Register Foreign Adoption Decree, and that the facts set forth in the foregoing Petition are true and correct to the best of my/our knowledge, information and belief. I/We further verify that all documents attached to this Petition are true and correct copies of the originals. I/We understand that false statements made herein are subject to the penalties of 18 Pa. C.S. § 4904 relating to unsworn falsification to authorities. Date: ____________________ Signature of Adopting Parent Signature of Adopting Parent American LegalNet, Inc. www.FormsWorkFlow.com