Petition and Agreement of Adult Adoption PC-603A

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CON	 NECTICUT PROBATE COURTS Petition a
nd Agreement  
of Adult Adoption  
PC-6 03A  NEW 10/14  	
RECEIVED: 
 Instructions : 1)  A n adult person may use this form to petition for approval of an agreement to adopt another adult   who 	
is younger in age, provided that the proposed adoptive parent and the adult to be adopted are not 
related as spou se, brother, sister, uncle or aunt, whether  of the whole or half blood .  	
2) The A	 greement of Adult Adoption contained in the petition must be signed by the proposed adoptive
parent (s) and the adult to be adopted.  
3) One parent of the adult to be adopted may join in the adoption agreement between the parent’s spouse
or one other person and the adult child.  The rights of a parent who does not join in the adoption 
agreement  will be terminated in accordance with subdivisions (5) (6) and (7) of C.G.S. section 45a -731. 
4) The petition must be filed in the probate district in which the adoptive parent resides.  If the adoptive
parent  does not reside in Connecticut, the petition should be filed in the district in which the adult to be 
adopted resides.  
5) For further information, see C.G.S. sec tions 45a-731 and 45a -734.
6 ) Type or print  the form  in ink. Use  an additional sheet or Second Sheet, PC -180 if more space is needed.	
Probate Court Name    District Number  
In the Matter of (List name, address  and telephone number of the adult to be adopted)       Date and  place of  birth of 	
  ad	 ult to be a	dopted          	
       Her	

einafter referred to as the adult to be adopted  
Proposed adopti ve parent (s) (List name,  address, telephone number  and date of birth of each proposed adoptive 
parent)        Parent of adult 
to be  adopted joining  in the  adoption agreement,  if any,  as addressed  in Instruction No.  3 above  
(List  name, address  and telephone number) 
Spouse of proposed adoptive  parent, if not a parent or p roposed adoptive  parent (List name,  address and 
telephone number)    
Other persons interested in the welfare of the proposed adoptive parent(s) or adult  to be adopted to whom notice 
of this petition should be give n (List name, address and telephone  number of each person)  
Petition and Agreement of Adult Adoption    PC-6
03A Page 1 of 3 CONFIDENTIAL

CONNE CTICUT  PROBA	 TE COURTS Petition a
nd Agreement  
of Adult Adoption 
PC-60 3A  NEW 10/14 	
        Adoption Agree	 ment 
The proposed adoptive parent(s), __________________________________________________________________,	 	
agree(s) to adopt _______________________________________,an adult who is younger than the adoptive parents .   ___________________________________, being over the age of 18, agrees to be adopted by the proposed 
adoptive parent(s). The 
adult to be adopted is not related as spouse, brother, sister, uncle or aunt,  whether of the 
whole or half blood, of  the proposed  adoptive parent(s).  
The proposed adoptive parent(s

) and the adult to be adopted share a relationship that is similar to that between a parent 
and an adult child.  
        There are two proposed adoptive parents.  
        There is one  proposed adoptive parent . 
  The  proposed adoptive parent  is married  to:  
 a  parent of the adult to be adopted. The parent is joining in the adoption agreement and does not 
relinquish any parental rights in and to the adult to be adopted. (See Instruction No. 3 above.)  
  a spouse who is not a parent  of the adult to be adopted. The spouse is consenting to the adoption 
agreement .     	
    a  s	pouse who is not a parent of the adult to be adopted. The spouse is not consenting to the adoption 
  agreement for the following reasons: 	
      The proposed adoptive parent is not married.         The parent of the adult to be
 adopted is not married to the proposed adoptive parent but is
 joining in the adoption
      agreement and does not relinquish any parental rights in and to the adult child. (See instruction No. 3 above.)          
WHEREFORE, THE PARTIES TO THE ADULT ADOPTION AGREEMENT REQUEST that the c ourt: 	
       Approve the adul	

t adoption agreement between the proposed adoptive parent (s) and the adult to be adopted.  
       C hange the name of the adult to be adopted to______________________________.  	
The representations contained herein are made under the penalties of false statemen t. 	
 P ARTIES TO THE  AGREEMENT	 	
 Signature of  Adult to be A dopted 	
    Type or Print Name 	
       Date   Signature of 
Proposed Adoptive Parent 	
    Type or print name  	
 Date   Signature of 
Proposed Adoptive Parent 	
    Type or print name  	
     Date  	
Petition and Agreement of Adult Adoption  PC-6
03A Page 2 of 3 CONFIDENTIAL

CONNE CT	 ICUT PROBATE COURTS Petition a
nd Agreement  
of Adult Adoption 
PC-6 03A  NEW 10/14  	
PARTIES TO THE AGREEMENT	(CONTINUED	) 	
PARENT OF ADULT CHIL D JOINING IN AGREEMENT	   Signature of 
Parent of Adult Child   	
 Type or print name 	
       Date  	
SPOUSE OF PROPOSED ADOPTIVE PARENT CONSEN TING IN AGREEMENT 	(IF NOT PARENT OF ADULT TO BE ADOPTED	)  Signature of 
Spouse of Proposed Adoptive Parent 	
       Type or print name 	
      Date 	
Petition and Agreement of Adult Adoption  CONFIDENTIAL 
PC-60
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