Fillable Adoption Decree Form printable pdf download

Probate Form No. 136

Adoption Decree

STATE OF VERMONT

PROBATE COURT

DISTRICT OF _______________________

IN RE ______________________

DOCKET NO. _____________

ADOPTION DECREE

The court has considered a petition for adoption of the minor, ____________________, filed under

Title 15A V. S. A. (The Adoption Act) and, based upon the evidence submitted at a hearing held on the

_________________ day of ________________________ 20_____, makes the following findings.

The original name of the minor adoptee, or the minor’s original initials are

____________________________________________________________

The said minor was born on the ______ day of _______________, 20_____, at

___________ (A.M./P.M.) In _______________________.

A petition for adoption of the said minor was duly filed by ______________________ on

the __________ day of ________________________ 20_____.

The said petitioner _____ is _____ is not married, and is not a stepparent of the adoptee.

It _____ has _____ has not been duly requested that a new birth certificate be issued by the

Supervisor of Vital Records with the following information therein set forth:

Father :

Name: ______________________________________

Date of Birth: ________________________________

Place of Birth : ________________________________

Mother:

Maiden Name: __________________________________

Name by Which Mother is Known: __________________

Date of Birth: ___________________________________

Place of Birth: __________________________________

The petition requests that the adoptee be known by the name of _____________________

_________________ upon the issuance of this decree.

The adoptee has been in the physical custody of the petitioner for at least 180 days.

Notice of this proceeding for adoption has been served or dispensed with as to those persons

entitled to receive notice under Part 4 of Article 3 of The Adoption Act.

Each necessary consent, relinquishment, waiver, disclaimer of parental interest, judicial

order terminating parental rights, including any order issued under Part 5 of Article 3 of The

Adoption Act, as required by the Adoption act, has been filed with the court.

10.

Any evaluation required by The Adoption Act has ben filed and considered by the court.

11.

Each petitioner is a suitable adoptive parent for the minor.

12.

All applicable requirement of The Adoption Act governing an interstate or intercountry

placement for the adoption have been met.

Adoption Decree Form