Petition For Adoption And Affidavit Of Petitioner(s) {CJ-P 87}

PETITION FOR ADOPTION AND AFFIDAVIT OF PETITIONER(S) In the matter of: First Name Middle Name Docket No. Commonwealth of Massachusetts The Trial Court Probate and Family Court Last Name Division To the Justices of the Probate and Family Court: 1. Information about the Petitioner (Print name of Petitioner 1) Petitioner's spouse (if married) must join in the petition: (Print name of Petitioner 2) (Address) (Apt, Unit, No. etc.) (City/Town) (State) (Zip) Primary Phone #: 2. The Petitioner(s) are desirous of adopting the following child: First Name Middle Name Last Name Date of birth: 3. Information about biological/legal parents: (Print name of parent) Place of birth: (city/town and state or country) (Print name of parent) (Address) (Apt, Unit, No. etc.) (Address) (Apt, Unit, No. etc.) (City/Town) (State) (Zip) (City/Town) (State) (Zip) 4. The Petitioner(s) are of sufficient ability to rear the child, and to provide suitable support and education for the child; AND the child has resided for at least six months in the home of the Petitioner(s). the child was the subject of a proceeding pursuant to G.L. c. 210, §3 where the Court dispensed with the need for consent of or notice to the parent(s) on a Petition for Adoption. the child was the subject of a surrender which was executed pursuant to G.L. c. 210, §2. At the time of the surrender the (biological/legal) mother was At the time of the surrender the (biological/legal) father was The Petitioner(s) request that the Court: allow the adoption of the above named child. allow child's name be changed to First Name Middle Name Last Name years old. years old. waive the residence requirement for good cause (explain): Date: Signature of Petitioner 1 Signature of Petitioner 2 (if married) American LegalNet, Inc. www.FormsWorkFlow.com CJ-P 87 (3/31/14) page 1 of 3 Information on Attorney for Petitioner(s), if any Signature of Attorney (Print name) (Address) (Apt, Unit, No. etc.) (City/Town) (State) (Zip) Primary Phone #: B.B.O. # Email: This Petition is sponsored, recommended, and approved by: (the agency's name and address) a charitable corporation organized under the laws of the Commonwealth of Massachusetts for the purpose of engaging in the care of children and principally so engaged. CONSENT OF CHILD I, this adoption. Date: , being above the age of twelve (12) consent to (Name of Child) Signature of Child Witness 1 Witness 2 NOTARIZATION The above signed that this consent is his/her free act and deed. Signature of Notary Public Print Name My Commission Expires (Name of Child) made oath before me on (date) CJ-P 87 (3/31/1 American LegalNet, Inc. www.FormsWorkFlow.com page 2 of 3 o AFFIDAVIT OF PETITIONER(S) FOR ADOPTION Parent 1 (Print name of Parent 1, including birth name if applicable) (Address) Parent 2 (Print name of Parent 2, including birth name if applicable) (Address) (Apt, Unit, No. etc.) (State) (Zip) (Apt, Unit, No. etc.) (State) (Zip) (City/Town) (City/Town) Primary Phone: (date of birth) Primary Phone: (date of birth) Place of Birth: (City/Town, State) (Country) Place of Birth: (City/Town, State) (Country) (County) (occupation at the time of adoption) (County) (occupation at the time of adoption) I hereby request that a certificate of adoption be sent to the city or town clerk of the place of the birth of the child and that a clerk of the records amend the birth certificate of the child to reflect this adoption. Date: Date: SIGNATURE OF PARENT 1 SIGNATURE OF PARENT 2 NOTARIZATION The above signed made an oath before me on Date: that this affidavit is Petitioner's free act and deed. The above signed made an oath before me on Date: that this affidavit is Petitioner's free act and deed. SIGNATURE OF NOTARY PUBLIC SIGNATURE OF NOTARY PUBLIC (Print name of Notary Public) (Print name of Notary Public) My Commission Expires My Commission Expires CJ-P 87 (3/31/14) American LegalNet, Inc. www.FormsWorkFlow.com page 3 of 3