Adoption Petition (Page 5 of 5) in pdf

Adoption Petition Page 5

Verification

[DO NOT SIGN YET. This must be signed in front of a clerk of court, notary public, or other

person authorized to administer oaths.]

I state on oath or affirm that I have read this petition and that all statements made in it are

true to the best of my knowledge and belief.

Date

Signature of Adoptive Parent

Date

Signature of Adoptive Parent

Subscribed and sworn to or affirmed before me at

, Alaska

(date)

(SEAL)

Clerk of Court, Notary Public, or other person

authorized to administer oaths.

My commission expires:

Certificate of Service

[File this petition with the court. If the adoption involves an Indian child, notice must be given to the

child’s tribe. Unless this is a stepparent adoption, you must serve a copy of this petition on the

Department of Health and Social Services at:

Office of Children’s Services

Adoption Unit

P.O. Box 110630

Juneau, AK 99811-0630

If this is the adoption of an Indian child, you must also serve a copy of this petition on the relevant tribe.]

I certify that on (date)

a copy of this petition was

mailed

hand delivered to [list everyone served and attach extra pages if necessary]:

Your signature:

Page 5 of 5

AS 25.23.080

P-405 (12/16)(cs)

Adoption Rule 6

PETITION FOR ADOPTION

Adoption Petition Page 5