Name _______________________ Address _______________________ _______________________ Phone _______________________ Petitioner Pro Se _____________ DISTRICT COURT, ___________________ COUNTY, UTAH Address __________________________________________________________ ________________________________________________________________________ IN THE MATTER OF: * ORDER OF REGISTRATION * OF FOREIGN ADOPTION * ________________________, * Case No. _________________ * A MINOR CHILD. * Judge: ____________________ ________________________________________________________________________ This matter came before the court on Petitioner’s Verified Petition to register the foreign country adoption of the minor child named above. The Court having reviewed the adoption order and Verified Petition, finds as follows: FINDINGS 1. The Petitioner is a resident of Utah and the current custodian of the minor child and has a direct, tangible, and legitimate interest as the adoptive parent of the minor child. 2. The following persons (which include Petitioner) have adopted the minor child: Father: ________________________________________, born ______________ Mother: _______________________________________, born ______________ 3. The adoption order was issued by a court of competent jurisdiction in the country of: ___________________________________________________. 1 8/04 American LegalNet, Inc. www.USCourtForms.com 4. The fact, time, and place of birth of the minor child are as follows: _____________________________________________________________ Sex of child: [ ] male [ ] female Names of biological parents (if available): Father ___________________________________________________ Mother ___________________________________________________ Birthdate of child: ______________________________ Country of birth _________________________________________________ Location of birth (equivalent of city, county, state; or, city, ward, province; etc.) _______________________________________________________________ ORDER Based upon the above findings the Court orders that the Registrar for the State of Utah prepare a birth certificate for the minor child changing the child’s name to _____________________________________________________________________. DATE ______________ BY THE COURT ___________________________ DISTRICT COURT JUDGE 2 8/04 American LegalNet, Inc. www.USCourtForms.com