STATE OF SOUTH CAROLINA ) IN THE FAMILY COURT ) ____ JUDICIAL CIRCUIT COUNTY OF ________________________ ) ) ) Petitioner(s), ) PETITION FOR DOMESTICATION vs. ) OF FOREIGN ADOPTION ) South Carolina Department of Health and ) § § 63-9-910(B), 44-63-140 Environmental Control ) Respondent(s). Docket No. ____________________________ In re: __________________________________________________________________________ The Petitioner(s) allege: ________________________________________________________ ____________________________________________________________________________ 1. The Petitioner(s) are citizens and residents of the county of_______________________, State of South Carolina, United States of America, with an address of: Street Address: ___________________________________ City ___________________________________ Zip Code: ___________________ 2. The ( male/ female) child adopted by the Petitioner(s), hereinafter referred to as "child," is presently named__________________________, and was born in the City of________________________, and Country of__________________________________________. 3. The child was born on the ____ day of the month of________________________, in the year of__________, and was not a United States citizen at that time. 4. The Petitioners adopted the child in the City of___________________________, located in the Country of___________________________________, as shown by the original decree of adoption issued by the foreign country in which the child was born, attached hereto as Exhibit A and incorporated herein by reference. 5. a. The Petitioners were approved to adopt this child by virtue of the foreign country's permission to adopt that was issued to them by a National Official, as more accurately set forth in Exhibit B attached hereto and incorporated herein by reference. SCCA 476 (12/2009) American LegalNet, Inc. www.FormsWorkFlow.com b. No specific permission to adopt was required, as set forth in the procedures for adoption attached hereto as Exhibit B and incorporated herein by reference. 6. The child was authorized to enter the United States as evidenced by Exhibit C attached hereto and incorporated herein by reference. 7. a. The child is a United States citizen by virtue of citizenship granted by Certificate Number ___________________________ with INS Registration Number_______________________, which was issued on ( / / ). A copy of the certificate, attached hereto as Exhibit D and incorporated herein by reference, reflects that the child's name is______________________________. b. The child is not a United States citizen. 8. The following documents, attached hereto as Exhibit E and incorporated herein by reference, were relied upon by the foreign country in the adoption process. __________________________________________________________________________________ __________________________________________________________________________________ 9. A post-placement report was conducted as evidenced by Exhibit F, attached hereto and incorporated herein by reference. 10. The Petitioners know of the following property, either real or personal, that the child owns: Description of Property Location of Property 11. The Petitioners attest that no other Certificate of Foreign Birth has ever been issued for the child by any other State in the United States of America. SCCA 476 (12/2009) American LegalNet, Inc. www.FormsWorkFlow.com 12. The Petitioners request that this Court grant the following relief: (Check one or more) a. An Order recognizing and domesticating the foreign adoption of the child in South Carolina. b. An Order directing the State Registrar to issue a Certificate of Foreign Birth showing Petitioners as the parents of the child. c. That the records of these proceedings be sealed. d. A name change for the child from his/her present name of _____________________________ to the new name of __________________________________________________________________. e. Other relief described as follows:_________________________________________________. WHEREFORE, the Petitioners pray that this Court inquire into the matter set forth herein and that it grant the relief requested in paragraph 12 and such other and further relief as the Court may deem just and proper. Date: ________________________, 20___ __________________________, S.C. Petitioners(s)/Attorney for Petitioner(s) Address: __________________________________ __________________________________ SCCA 476 (12/2009) American LegalNet, Inc. www.FormsWorkFlow.com