Petition For Adoption Of An Adult {NHJB-2519-P}

THE STATE OF NEW HAMPSHIRE JUDICIAL BRANCH http://www.courts.state.nh.us Court Name: Case Name: Case Number: (if known) In the adoption of PETITION FOR ADOPTION OF AN ADULT (RSA 170-B) A CERTIFIED COPY (LONG FORM) OF THE ADOPTEE'S BIRTH CERTIFICATE AND ASSENTS MUST BE FILED WITH THIS PETITION. 1. Petitioner Name Petitioner Name Mailing Address Residence How long has petitioner(s) been resident(s) of this city/town? 2. Attorney Name Mailing Address 3. Marital status of petitioner(s): Married Civil Union Single Date of Birth Date of Birth Telephone Telephone Bar ID # Other If married or civil union, date and place of ceremony 4. 5. Petitioner(s) relationship to adoptee Adoptee Birth Name Date of Birth Residence Address Telephone Place of Birth 6. Birth Mother Name Mailing address Telephone 7. Birth Father Name Mailing address Telephone The petitioners declare that it is the desire of the petitioners to establish the relationship of parent and child with the adoptee. Therefore, the petitioners ask that this adoption be decreed and that the name of the adoptee be as follows: (Check all appropriate boxes. See Instructions for more information.) Change the name on the adoptee's birth certificate to The adoptee's legal name will be Date Date NHJB-2519-P (03/10/2010) Petitioner Signature (Must be signed in presence of notarial officer.) Petitioner Signature (Must be signed in presence of notarial officer.) Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com Case Name: In the adoption of Case Number: PETITION FOR ADOPTION State of This instrument was acknowledged before me on , County of by Date Petitioner Name My Commission Expires Affix Seal, if any Signature of Notarial Officer / Title ASSENTS ADOPTEE'S ASSENT I am the adoptee mentioned in this petition. I give my assent to the adoption and the change of my name as described in this form. Date Adoptee's Signature Presiding Judge Signed in the presence of ASSENT OF PETITIONER'S SPOUSE WHO IS PARENT OF ADOPTEE I am the spouse of the petitioner and parent of the adoptee, and will maintain all those parental rights along with the petitioner. I give my assent to the petitioner's adoption of the adoptee named in this petition and to the change of the adoptee's name as described in this petition. Date Parent Signature ASSENT OF PETITIONER'S SPOUSE TO ADOPTION OF ADULT I am the spouse of the petitioner, and assent to the petitioner's adoption of the adoptee named in this petition. Date Spouse Signature ASSENT OF ADOPTEE'S SPOUSE I am the spouse of the adoptee, and I assent to this adoption. Date Spouse Signature DECREE Petition for adoption is granted. Petition for adoption is denied. Date Judge NHJB-2519-P (03/10/2010) Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com