COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : CASE NUMBER: I. Index No. Calendar CASE NAME: No. ADOPTION CHECKLIST AND CERTIFICATION FOR FINAL HEARING REQUEST : : : : : : .. II. ........... Plaintiff(s) SUMMONS COMPLAINT/PETITION ( 20-7-1730 ) -againstVERIFICATION ( optional ) GUARDIAN AD LITEM: A. FOR ADOPTEE: 20-7-1732 PETITION ORDER ANSWER B. FOR MINOR BIRTH PARENT: PETITION Defendant(s) ORDER . . . . . . . . . . . . . .ANSWER. . . . . . . . . . . . . . . . . . . . . . ..... C. PLEADINGS: JUDICIAL SUBPOENA INCOMPETENT BIRTH PARENT 20-7-1695(A)(2) PETITION ORDER THE PEOPLE OF THE STATE OF NEW YORK ANSWER ORDER OF TRANSPORT FOR BIRTH PARENT INCARCERATED IN SC IF NO G.A.L. TO III. SERVICE: COMPLAINT/PETITION ADULT DEFENDANTS G.A.L ADOPTEE UNDER AGE 14 20-7-1732 INCOMPETENT BIRTH PARENT GREETINGS: MINOR BIRTH PARENT ADOPTEE ( IF OVER 14 YEARS OLD ) 20-7-1732 COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before IV. WE CONSENT OR RELINQUISHMENT: CONSENT WHERE NO TPR: the HonorableA. at the Court BIOLOGICAL MOTHER located FATHER at County of BIOLOGICAL CHILD OVER 6 MONTHS AT PLACEMENT 20-7-1690(A)(4) in room , on the day of , 20 , at o'clock in the noon, and at any recessed CHILD LESS THAN 6 MONTHS AT PLACEMENT or adjourned date, to testify and give evidence as a witness in this action on the part of20-7-1690(A)(5) the ADOPTEE ( IF OVER 14 YEARS OLD ) LEGAL FATHER B. NOTICE WHERE NO CONSENT OR TPR: BIOLOGICAL FATHER Your failure to comply with this subpoena is CSC OR INCEST a contempt of court and will make you liable to punishable as 20-7-1734(C) NO NOTICE REQUIRED V. INVESTIGATIONS AND REPORTS: 20-7-1740 and 20-7-1775 the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a BACKGROUND INVESTIGATION ON BIOLOGICAL PARENTS result of your failure to comply. PRE-PLACEMENT INVESTIGATION POST-PLACEMENT INVESTIGATION ITEMIZED ACCOUNTING OF DISBURSEMENTS Witness, REQUIREMENTS: 20-7-1760 Honorable , one of the Justices of the VI. TIME 90 DAYS HAVE PASSED SINCE , 20 FILING OF THE PETITION THE Court in County, day of NO MORE THAN 6 MONTHS HAVE PASSED SINCE THE FILING OF THE PETITION NO MORE THAN 12 MONTHS HAVE PASSED SINCE THE FILING OF THE PETITION AND THE CHILD IS A SPECIAL NEEDS CHILD GOOD CAUSE EXISTS FOR EXTENDING OR SHORTENING THE TIME type name below) (Attorney must sign above and WITHIN WHICH THE FINAL HEARING MAY BE HELD VII. DSS PLACEMENT: ADOPTION PLACEMENT CERTIFICATE ANSWER Attorney(s) for PROOF OF SERVICE ON DSS NOTICE TO DSS VIII. NON-RESIDENT ADOPTION: INTERSTATE COMPACT APPROVAL JUDICIAL DETERMINATION 20-7-1670 IX. STEP-PARENT OR BLOOD RELATIVE ADOPTIONS: NO INVESTIGATIONS AND REPORTS REQUIRED and P.O. Address Office 90 DAY WAITING PERIOD MAY BE WAIVED I HEREBY CERTIFY THAT I HAVE REVIEWED THE COURT FILE IN THIS ACTION AND THAT ALL OF THE STATUTORY REQUIREMENTS HAVE BEEN MET AND THIS CASE IS READY TO BE SET FOR FINAL HEARING. , Telephone No.: ________________, 200__ ____________________________________________ Facsimile No.: ATTORNEY FOR PETITIONER(S) E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com