FORM SUMMARY Name of Form: Petition for Adoption--Child/Adult Form Number: JC-1645 Statutory Reference: §48.90, ch. 882, Wisconsin Statutes Purpose of Form: Petition to the court requesting the court approve an adoption of a child or adult. Who Completes It: Petitioner bringing the action. Distribution of Form: Original to court; copy to interested persons. Accompanying Forms: Generally none. New Form/Modification: Modification, last update 7/96. Modifications: Added a file/date stamp area to upper left corner. Added a statement on the bottom indicating that the form shall not be modified. Comments: None About this form: This form is the product of the Wisconsin Records Management Committee, a committee of the Director of State Court's Office and a mandate of the Wisconsin Judicial Conference. If you have additional information that does not change the meaning of the form, attach it on a separate page. The form itself shall not be altered. Date: 11/19/99 Page 1 2001 © American LegalNet, Inc. For Official Use STATE OF WISCONSIN, CIRCUIT COURT, COUNTY Petition for Adoption Child Adult IN THE MATTER OF THE ADOPTION OF Name Case No. Date of Birth Under oath, I petition the court for an order for adoption of this person, and state that: (For child adoptions, fill out sections 1-7) (For adult adoptions, fill out sections 1, 8, 9 and 10) 1. I am a relative of the child by blood. the child’s stepparent. a proposed adoptive parent with whom the child has been placed. an adult proposing to adopt another adult. My address is My telephone number is 2. The parental rights of the mother were terminated and a certified copy of the Order Terminating Parental Rights is attached. will be terminated on in court. other: 3. The parental rights of the father were terminated and a certified copy of the Order Terminating Parental Rights is attached. will be terminated on in court. other: 4. The guardian is consent is attached. consent will be provided prior to the hearing. 5. 6. 7. 8. 9. 10. The child has lived in my home since The adoption is in the best interests of the child. The child’s name should be changed to I am a resident of Wisconsin and wish to adopt this person. The consent of the adoptee: accompanies this petition The consent of my spouse (if not a co-petitioner): accompanies this petition and the will be signed at the hearing. will be signed at the hearing. Subscribed and sworn to before me Signature of Petitioner on Name Printed or Typed Notary Public, State of Wisconsin Signature of Petitioner My commission expires: Name Printed or Typed Distribution: 1. Court - Original 2. Interested Persons Date JC-1645, 11/99 Petition for Adoption – Child/Adult §48.90 and Chapter 882, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. 2001 © American LegalNet, Inc.