Petition For Adoption Form
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6DISTRICT COURT, COUNTY OF _________________________________, STATE OF MINNESOTA
In the Matter of the Welfare of __________________________________________, a Child, and the Petition
Of _____________________________ and ____________________________, his Wife, to Adopt said Child.
PETITION FOR ADOPTION
Your petitioners respectfully represent and show to the court:
1. That they are husband and wife and were married on _______________________________________ at
_______________________________, that their full names are _________________________________
and _____________________________; that their respective ages are _________ and ________ years; that
their place of residence is ___________________________________________________ in the County of
____________________________, State of Minnesota; that they have resided in the State of Minnesota for
more than one year immediately preceding the filing of this petition; that they are related to the child to be
adopted as ________________________________________ which is a relationship by blood or marriage
within the third degree***;
2. That they acquired physical custody of __________________________________________________ from
______________________________________ on _____________________________ and that said child
has lived in their home since said date.
3. That said child was born in the _________________________ of __________________________ County
of ________________________, State of ___________________________ on _____________________.
4. That the mother of said child is ___________________________________________ and that the father is
___________________________; that the guardian of said child is _______________________________.
5. That the actual name of the child and any known aliases are _____________________________________
_____________________________________________________________________________________.
6. That your petitioners desire to have the name of the child changed to ______________________________
_____________________________________________________________________________________.
7. That the description and value of any real or personal property owned by said child are as follows:
8. That your petitioners desire that the relationship of parents and child be established between petitioners and
the child, and that it is to the best interest of the child for the child to be adopted by them.
9. That the parent(s) (guardian)(agency)(Commissioner of Human Services) have consented to the adoption as
hereinafter shown; or that no consent is required because _______________________________________.
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