Petition For Adoptive Placement
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Petition For Adoptive Placement Form. This is a Wisconsin form and can be use in Circuit Court Statewide.
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Tags: Petition For Adoptive Placement, JC-1640, Wisconsin Statewide, Circuit Court
COUNTY
STATE OF WISCONSIN, CIRCUIT COURT,
IN THE INTEREST OF
For Official Use
Petition for
Adoptive Placement
a person under the age of 18.
Case No.
Date of Birth
UNDER OATH, I STATE THAT:
1.
a. The child was born on the date indicated above and resides at:
.
b. The child is due to be born about
2. The birth mother
resides at
3. The birth father
resides at
, age
4. The proposed adoptive mother
resides at
, age
5. The proposed adoptive father
resides at
,
, age
, age
6. (Person/agency)
.
,
.
,
.
,
.
arranged placement of the child.
7. The report of financial, medical and legal arrangements is attached.
8. The placement is in a licensed foster home.
9. The Petition for Termination of Parental Rights accompanies this petition.
10.
a. The child is not subject to the federal Indian Child Welfare Act.
b. The child is subject to the federal Indian Child Welfare Act, and:
1. Indian tribe’s name and address:
2. Indian custodian’s name and address: (if applicable)
Placement has been made in accordance with the order of preference set forth in the
3.
Indian Child Welfare Act.
OR
There is good cause to depart from the order of placement preference in the Indian Child
Welfare Act:
Subscribed and sworn to before me
on
Petitioner
Notary Public, State of Wisconsin
Name Printed or Typed
My commission expires:
Petitioner
Distribution:
1. Court-Original
2. Parties
3. Tribe (if any)
Name Printed or Typed
Date
JC-1640, 04/09 Petition for Adoptive Placement
§48.837, Wisconsin Statutes; 25 U.S.C. §1915.
This form shall not be modified. It may be supplemented with additional material.
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