IN THE COURT OF COMMON PLEAS OF _____________________________ COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION (FAMILY COURT DIVISION in Philadelphia County) IN RE: ADOPTION OF ______________ (initials only) ADOPTION NO. ______________________ PRELIMINARY DECREE AND NOW, this ______________ day of __________________, 20__, upon consideration of the within Petition and on the motion of _________________, Esquire, attorney for Petitioner(s) or______________________, Pro Se, a hearing thereon is fixed for ________________________________________________ in ________________________ before the Honorable ________________________ at __________ am/pm. Notice shall be given to the following persons and or entities having any legal and/or physical rights to the child: 1. NAME ADDRESS RELATIONSHIP 2. NAME ADDRESS RELATIONSHIP 3. NAME ADDRESS RELATIONSHIP ____________________________________ J. American LegalNet, Inc. www.FormsWorkFlow.com