Request To Social Services Agency To Conduct Post-Placement Assessment {ADO-501}

State of Minnesota County District Court Judicial District: Court File Number: Case Type: Adoption In Re the Petition of: , Petitioner and , Petitioner To Adopt: . (child's birth name) Request to Social Services Agency to Conduct PostPlacement Assessment, Background Study, and Minnesota Fathers' Adoption Registry Search Enclosed is an adoption petition filed in the above adoption matter in the above-named court. Pursuant to Minnesota Statutes § 259.53, subd. 1(b), this case is being referred to your office to conduct the following: Post-placement assessment ­ please conduct a post-placement assessment as required under Minn. Stat. § 259.53, subd. 2, and submit a report to the court within 90 days of the date of receiving this request and the enclosed adoption petition. Background study ­ please contact the petitioner(s) to commence and conduct a background study on all persons age 13 or older living in the adoptive home and submit a report to the court within 90 days of receiving this request and the enclosed adoption petition. Fathers' Adoption Registry check ­ please request a search of the Minnesota Father's Adoption Registry and submit certification of the search and the search results to the court within 90 days of receiving this request and the enclosed adoption petition. Pursuant to Minn. Stat. § 259.41, subd. 1(b), the social services agency may charge a reasonable fee for conducting the background study. Please contact me if you have any questions. Dated: _________________ ___________________________________ Court Administrator By: ________________________________ Deputy Court Administrator Address: City: State: Phone: Cc: (adoptive parent(s)) ADO501 State ENG Rev 11/15 www.mncourts.gov/forms Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com