JC-1645, 02/18 Petition for Minor Child Adoption 24748.90, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. STATE OF WISCONSIN, CIRCUIT COURT, COUNTY IN THE MATTER OF THE ADOPTION OF Name Date of Birth Petition for Minor Child Adoption Case No. UNDER OATH: I petition the court for an Order for Adoption of this person, and state: 1. I am a relative of the child by blood. parent. a proposed adoptive parent with whom the child has been placed. My address is . My telephone number is . 2. The parental rights of Parent 1 [Name] 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 Parent 2 [Name] 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 and the consent is attached. consent will be provided prior to the hearing. 5. The child has lived in my home since . 6. The adoption is in the best interests of the child. 7. [First] [Middle] [Last] . 8. The child is is not may be subject to the federal Indian Child Welfare Act. Tribe/address: State of County of Subscribed and sworn to before me on Notary Public/Court Official Name Printed or Typed My commission/term expires: Petitioner Name Printed or Typed Signature of Petitioner Name Printed or Typed Date DISTRIBUTION: 1. Court 2. Interested Persons American LegalNet, Inc. www.FormsWorkFlow.com