P-405, Alaska Adoption Petition

The following petition is carried out by the adoptive parent who is in that case, the petitioner requesting an adoption action in court. In this consent form, the Superior Court of Alaska has a jurisdiction over the adoption proceedings.

Extracted Text for Proper Search

Page 	1 of 	5 	AS 25.23.080	 	
P-405 (	12/16	)(cs)	 	Adoption Rule 6	 	
PETITION 	FOR	 ADOPTION	 	
 	
IN  THE  SUPERIOR  COURT  FOR  THE  STATE  OF  ALASKA	 	
 	AT 	 	 	
 
In the matter of the adoption of	 	) 	
 	) 	
 	) 	
 	 	) 	
 	(child's name after adoption)	 	) 	
 	 	) 	
DOB: 	 	, A Minor Child,	 	) 	
 	) 	
By 	 	, 	) 	CASE NO. 	 	 	
 	Petitioner.	 	) 	
 	) 	ADOPTION PETITION	 	
 
I. 	Court Information	 	
This is	 the correct court to hear this matter because:	 	
 The child has an 	open CINA matter.  Case number (if known) 	 	. 	
 This is the location where the CINA proceedings are pen	ding.	 	
 While the CINA proceedings are not in this location, the petitioner resides in this 
district and:	 	
 does not know the CINA parties and asks the Alaska Court System to send 
notice.	 	
 has filed notice to the CINA parties.	 	
 Proof of notice is attached to this petition.	 	
 Proof of consent is attached to this petition.	 	
 There is no open CINA matter for the child, and this location is where	: 	
 The person(s) seeking to adopt the child resides or is in the military.	 	
 The child resides at the t	ime of filing.	 	
 	 The agency that has care, custody, or control of the child is located.	 	
 
II. 	 	Child’s Information	 	
a. Child’s current full name 	(leave blank if an agency adoption)	:  	 	
b. Child’s name after adoption: 	 	 	
c. Child was born on 	 	, in 	 	,  	. 	
 	 	 	(date)	 	(city)	 	(state or country)	 	
d. Child’s current address: 	 	 	
e. Number of years child has lived at the above address: 	 	 	
f. 	Name of birth parents, if known:

Page 	2 of 	5 	AS 25.23.080	 	
P-405 (	12/16	)(cs)	 	Adoption Rule 6	 	
PETITION 	FOR	 ADOPTION	 	
 
g. The child has no 	property of significant value, except:	 	
 	[Includes money in bank accounts, ANCSA Corporation shares, real property, jewelry etc.	] 	
 	Description of Property	 	Estimated Value	 	
 	 	 	 	
 	 	 	 	
 	 	 	 	
h. Does the child qualify as an Indian child? 	(Child is a member of an 	Indian tribe	; or	 child is 	
eligible for membership	 in a tribe and	 either of the child's biological parents is a member of 	
an Indian tribe.)	 	
 	 No.	 	
 	 Yes.  Fill out P	-450, Report of Indian Adoptive Placement.	 	
i. 	To my knowledge and belief, there  	 are  	 are not	 	any other 	court cases	 	
involving this child now pending in a 	state or tribal 	court in Alaska or in another state	 	
(including tribal courts)	. 	
 	Type of Court Case	 	 	 	Where	 	 	 	Case No., if known	 	 	
 	 	 	 	 	 	
 	 	 	 	 	 	
 	 	 	 	 	 	
 	 	 	 	 	 	
 	
III. 	Petitioner 	Information	 	
a. Name of Adopting Parent(s):	 	
 	 	 	 	
b. 	 Marital Status:	 	 not married.	 	
 	 	 married	.  Spouse’s name	:  	. 	
 	 	Marriage occurred on 	 	, in 	 	. 	
 	          	(date)	 	(city)	 	(state)	 	
c. Address: 	 	 	
d. 	 Number of years you have 	lived 	in the above city: 	 	 	
e. 	 Tele	phone Number: 	 	 	
f. 	 I/we	 have 	a place to live	 and resources suitable to prov	ide for the nurture and care of 	
 	the child and I	/we	 desire to establish the relationship of parent and child with this child.

Page 	3 of 	5 	AS 25.23.080	 	
P-405 (	12/16	)(cs)	 	Adoption Rule 6	 	
PETITION 	FOR	 ADOPTION	 	
 
IV.	 	Adoption Information	 	
a. What kind of adoption is this?	 	
 Agency adoption	 (Office of Children Services does not count as an agency adoption)	 	
 	 	Name of Agency: 	 	 	
 Independent 	adoption	 	
 	 	 Relative 	 	 Nonrelative	 	
 Stepparent adoption	 	
b. 	 Is this an adoption of an Indian child?	 	
 No	. 	
 Yes.	 	
 	I/we should be the adoptive parent because: 	 	
 I am a member of the child’s extended family.	 	
 I am another member of the child’s tribe.	 	
 I am a member of another Indian tribe	. 	
 I believe there is good cause to deviate from 	the Indian Child Welfare Act’s	 	
adoptive 	placement 	preferences.	 (See 25. U.S.C. 1915(a).)	 	
 	 	
 	 	
 	 	
 	 	
c. Consent	. 	
1. All the following persons whose consent 	is required by Alaska Statute 25.23.040 	
have consented to this adoption:	 	
 The mother of the minor.	 	
 The father of the minor. 	 	
 The 	minor	, if the 	minor	 is age 10 or older.  	 	
 Any	 spouse of the child to be adopted.	 	
 Any other person who is lawfully entitled to custody of the child or empowered 
to consent.  Person	 or agency	's name:	 	. 	
 	
Consent forms from each of the above persons accompany this petition.  I 
understand that 	consent or relinquishment must be signed in a hearing in 	
the presence of a judge	 or a special master	 when:	 the consenting 	parents are 	
the parents of an	 Indian child, the consenting parent is a minor, 	or 	the	 consenting	 	
child to be adopted is over the age of 10.

Page 	4 of 	5 	AS 25.23.080	 	
P-405 (	12/16	)(cs)	 	Adoption Rule 6	 	
PETITION 	FOR	 ADOPTION	 	
 	
2. If 	consent is not required 	because of 	a reason recognized	 in AS	 25.23.050	, please 	
state the reason	. 	
 	Name	 of person whose consent	  	Reason	 	
 	is not needed:	 	 	
 	 	 	 	 	
 	 	 	 	 	
 	 	 	 	 	
d. Visitation 	after	 the Adoption. AS 25.23.130.	  	
1. The parent 	consenting to the adoption of the child	 has requested that he/she/other 	
relative	 	 will	 	 will not	 	be allowed	 visitation with the child following the 	
adoption, as specified in that parent's consent.  	 	
2. I 	 agree 	 	do not agree 	 	with this request.	 	
e. I believe that this adoption is in the best interests of this child.	 	
f.  I/we also	 filed	 the following:	 	
1. a certified copy of the child's birth certificate (	or verification of the birth record	), 	
2. a filled out form 	VS	-550, Descriptive Information Regarding Biological Parents	, 	
3. a filled	-out form VS	-501, Report of Adoption	, 	
4. the required consent	 forms	, and	 	
5. the report of expenditures required by AS 25.23.090.	 	
[If I am unable to provide any of the above five requirements at the time of filing, my petition 
will	 still be accepted by the court, h	owever, my petition will be 	deficient until complete.]	   	
g. I/we	 ask the court to:	 	
 	1. grant this petition for adoption and declare the child to be my child for all legal 
purposes, 	 	
 	2. declare that the child will be known from now on by the name shown at the top of 
page one of this 	petition, and	 	
 	3. order that a new birth certificate be issued for the child	. 	 yes	 	 no

Page 	5 of 	5 	AS 25.23.080	 	
P-405 (	12/16	)(cs)	 	Adoption Rule 6	 	
PETITION 	FOR	 ADOPTION	 	
 	
Verification	 	
[DO NOT SIGN YET. This must be signed in front of a clerk of court, notary public, or other 	
pe	rson 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 	
on 	 	. 	
 	(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 Ser	vices	 	
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: