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PETITION FOR ADOPTION
State of New York

IN THE [  ] DISTRICT [  ] SUPERIOR [  ] CIRCUIT COURT
OF [COUNTY] COUNTY, NEW YORK

Case No.: [TO BE ASSIGNED]

PETITION FOR ADOPTION

Petitioner(s):
Name: [ADOPTIVE PARENT 1]
Address: [ADDRESS], NY [ZIP]
Name: [ADOPTIVE PARENT 2] (if applicable)
Address: [ADDRESS], NY [ZIP]

Child to be Adopted:
Current Legal Name: [CHILD'S NAME]
Date of Birth: [DOB]
Place of Birth: [CITY, STATE]
Current Residence: [ADDRESS]

1. Petitioner(s) are residents of [COUNTY] County, New York.
2. Petitioner(s) are [  ] over 18 [  ] over 21 years of age (per New York requirements).
3. The child has resided with Petitioner(s) since [DATE].
4. Relationship to child: [  ] Stepparent [  ] Relative [  ] Foster parent [  ] No prior relationship

5. CONSENT:
   [  ] Birth mother has consented
   [  ] Birth father has consented
   [  ] Parental rights have been terminated by court order
   [  ] Consent is not required because: [EXPLAIN]

6. Petitioner(s) request the child's name be changed to: [NEW NAME]

WHEREFORE, Petitioner(s) request this Court grant the adoption in accordance with New York adoption law (NY Statutes).

PETITIONER 1: _____________________ DATE: _____
PETITIONER 2: _____________________ DATE: _____

VERIFICATION:
Subscribed and sworn before me this ___ day of _______, 20__.
Notary Public: _____________________