Form Dss-1800- Petition For Adoption Of A Minor Child - Child Welfare Services
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3STATE OF NORTH CAROLINA
IN THE GENERAL COURT OF JUSTICE
DISTRICT COURT DIVISION
___________________COUNTY
BEFORE THE CLERK
______ SP __________
___________________________________________________
(Full name of petitioning parent 1)
___________________________________________________
(Full name of petitioning parent 2)
PETITION FOR ADOPTION
OF A MINOR CHILD
FOR THE ADOPTION OF
(Not Stepparent)
____________________________________________________
(Full name by which adoptee is to be known if adoption granted)
To the Honorable Clerk of the Superior Court of ______________________________________ County:
We (I), the undersigned, ___________________________________________________________, ___________, and
(Name of petitioning parent 1)
(Sex)
_________________________________________________________________, _______________, whose address is
(Name of petitioning parent 2)
(Sex)
_______________________________________________________________________________________________,
(Street & Number)
(City)
(County)
(State) (Zip Code)
do hereby petition the Court to adopt _________________________________________________, a ________ minor
(Name by which the adoptee is to be known)
(Sex)
child, and do represent to the Court:
1.
That the petitioner(s) herein seeking adoption:
has/have lived in or been domiciled in North Carolina for at least six consecutive months immediately
preceding the filing of this petition; OR
has/have lived in or been domiciled in North Carolina for less than six consecutive months prior to filing
this petition, but the adoptee has lived in North Carolina for at least six consecutive months immediately
preceding the filing of this petition or from birth; OR
does/do not reside or have domicile in North Carolina, but is/are petitioning to adopt a child currently in
the legal custody of a licensed NC adoption agency or county department of social services; OR
does/do not reside or have domicile in North Carolina, but is/are petitioning to adopt a child directly
placed with the petitioner(s) by the birth parent(s) and the child has lived in North Carolina for at least six
consecutive months immediately preceding the filing of this petition or from birth AND continues to
reside in North Carolina at the time of the filing of this petition.
2.
That any required preplacement assessments have been completed or updated within the 18 months before the
adoptee's placement for the purpose of adoption or an affidavit is attached stating why the assessment is not
available.
3.
That all necessary consents, relinquishments, or terminations of parental rights have been obtained and
have been filed or will be filed as additional documents with the petition; AND/OR
DSS-1800 (Rev. 11/2014)
Child Welfare Services
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