Petition for Adoption

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Rev. 11/14

1 of  2 	
F	

orm 150 
(Rev.  10/11) 	
The Family Court of the State of Delaware  	
In and For 	 New Castle  	 Kent  	 Sussex County  	
PETITION FOR ADOPTION  	
In the Matter of:  
Petitioner  2	nd Petitioner (if any)  	
IN THE INTEREST OF THE FOLLOWING CHILD(REN): (Complete the table below for each child  whom 
petitioner seeks to adopt.  Attach additional sheets if necessary.)  
Child’s Name	 	
Petitioner’s 
Relationship to Child	 	
Child’s Date of 	
Birth	 	
Child’s Place of Birth 
(City, State)	 	Child’s Gender 
Male 	Female	 	
Male 	Female	 	
Male 	Female	 	
1. N

ame of the person, persons, or organization legally qualified to consent to the adoption:
Person or Organization	 	Address	 	
Date of 
Child’s 
Placement  
in Adoptive 
Home	   	
OR… 	
If Child is Being Adopted 
by Stepparent; Date of 
Marriage between 
stepparent and natural 
parent	 	
2.  T

he child(ren) will assume the following name(s) upon adoption:
Name	 	Name	 	File Number	 	
Street Address	 	Street Address	 	
P.O. Box Number	 	P.O. Box Number	 	
City	/State/Zip Code	 	City	/State	/Zip Code	 	
Home Phone	 	Work Phone	 	Home Phone	 	Work Phone	 	
Relationship to Child(ren)	 	Relationship to Child(ren)	 	
Marital Status: 	 	Married	 	Single	 	Marital Status: 	 	Married	 	Single	 	
Attorney Name	 	Attorney Name	 	
 Interpreter needed? 	 Yes  	 No	 	 Interpreter needed? 	 Yes  	 No	 	
 Language 	   	 Language

F	
orm 150 
(Rev.  10/11) 	
3.	Is child being brought into this State from another state or country for adoption in this state?   	Yes	No 	
If YES, I have attached proof of compliance with the Interstate Compact for the Placement 
of Children in the form of written approval from the Delaware Division of Services for 
Children, Youth and Family Services.  	
4. I have attached the birth certificate  of the child, not	 the certificate of live birth.	
5.  I

 have attached the mandatory  Affidavit of Expenses (Form 156).
6. Is the child being adopted 14 years of age or over?	 	Yes	No	 	
If YES, I have attached an  Affidavit of Consent of Child 14 years of Age or Older  (Form 
159) . 	
7. H

as the person(s) legally qualified to consent to the adoption consented to this Petition for Adoption?	
If YES,  I have attached the following:  	
Affidavit of Consent of Natural Parent whose Spouse is Petitioning for Adoption 
(	Form 158) 	
 A certified copy of the marriage certificate between the natural parent and step  	
  p arent   	
Consent to Termination and Transfer of Parental Rights  (Form 140)  	
8. I (	do 	do not) wish to request a hearing/ceremony if the adoption is granted.  I understand that havin	g	
a hear	

ing/ceremony is solely within the discretion of the hearing officer.   	
W

HEREFORE , Petitioner(s) seeks to adopt the above- named minor child(ren). 	
Petitioner/Petitioner’s Attorney	 	Petitioner 2, 	if any	 	
Date	 	Date	 	
Sworn to and subscribed before me this 	Sworn to and subscribed before me this 	
day of  	day of	 	
Notary Public or Clerk of Court	 	Notary Public or Clerk of Court	 	
AFFIDAVIT OF TRUTH	 	
I, 	, state the information in this Petition for Adoption is tru	e and	 	
correct to the best of my knowledge.	 	
Affiant	 	
Sworn to subscribed before me this ______ day of ______________________, 	_________	 	
Notary Public	 	
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1 of  3 	
F	

orm 346 
Rev. (01/13)	
 	
The Family Court of the State of Delaware  	
In and For 	 New Castle  	 Kent  	 Sussex County  	
CUSTODY SEPARATE STATEMENT  	
Petitioner  v.	R	 espondent	
1.What type of petition are you filing?
2. Who is the child(ren) named in your petition? ( Please provide full name and date of birth)	
Child’s Name	 	Date of Birth (mm/dd/yyyy)	 	
3.Have all the children listed above continually resided with one another?  	 Yes   	No	
If you  answered “No,” the children have not continually resided with one another; please complete a
Custody Separate Statement for each child.	
CURRENT ADDRESS  	
Address where child(ren) 	currently 	resides   ** If the 	address where the child(ren) currently resides is  a confidential address in Family Court, DO NOT provide the address on this form.  Instead, please mark the fields as CONFIDENTIAL	. 	
Date(s) Child(ren) lived here	 	
S

tate  	
Z

ip Code 	
 to present	 	
City  	
Name of person(s) child(ren) is living with	 	Relationship to child(ren)	 	
4.Durin g the past five years, where have the child(ren) lived?  List addresses from the most recent to the oldest	.	
If the child(ren) is under the age of five years old, end with the first address where the child lived.	 	
PRIOR ADDRESS 	
Address where child(ren) 	previously	 reside	d 	City	 	State	 	Zip Code	 	
Date	(s) child(ren) lived there	 	Name of person(s) child(ren) lived	 with	 	Relationship to child(ren)	 	
to 	
Person’s current 	 address	 	City	 	State	 	Zip Code	 	
 PRIOR  ADDRESS 	
Address where child(ren) previously resided	 	City	 	State	 	Zip Code	 	
Date(s) child(ren) lived there	 	Name of person(s) child(ren) lived	 with	 	Relationship to child(ren)	 	
to 	
Person’s current 	 address	 	City 	State	 	Zip Code	 	
PRIOR ADDRESS  	
Address where child(ren) previously resided	 	City	 	State	 	Zip Code	 	
Date(s) child(ren) lived there	 	Name of person(s) child(ren)	 lived	 with	 	Relationship to child(ren)	 	
to 	
Person’s current 	 address	 	City	 	State	 	Zip Code	 	
PRIOR ADDRESS 	
Address where child(ren) previously resided	 	City	 	State	 	Zip Code	 	
Date(s) child(ren) lived there	 	Name of person(s) child(ren)	 lived	 with	 	Relationship to child(ren)	 	
to 	
Person’s current	  address	 	City	 	State	 	Zip Code	 	
Name	 	Name	 	File Number

F	
orm 346 
Rev. (01/13)	
 	
5. C	

heck ONE and complete as directed.	
No one other than the parties have physical custody, legal custody or visitation rights with the 
child(ren).  
A person(s) other than the parties have physical custody, legal custody or visitation rights with 
the child(ren).  If you check this box, complete the information below. Attach additional sheets if 
necessary.   	
PERSON  1 	
Name of person(s) 	with physical custody, legal custody or visitation	 	Relat	ionship to child(ren)	 	
Person’s current address	 	City	 	State	 	Zip Code	 	
PERSON 2 	
Name of person(s) 	with physical custody, legal custody or visitation	 	Relationship to child(r	en)	 	
Person’s current address	 	City	 	State	 	Zip Code	 	
6.S	

elect all that apply  and complete as directed.	
I have not been involved in any other court action for custody and/or visitation of this child(ren).  
I have been involved in another court action for custody and/or visitation of this child(ren). If you 
check this box, complete the information below. Attach additional sheets if necessary.  	
ACTION 1 	
Type of Action	 (e.g.	 Custody, Visitation, Other	) 	Person	 (who filed the action)	 	State	 	
Court	 	Case Number	 	Date Filed	 	
Result	 	Date of Order	 	
ACTION 2 	
Type of Action	 (e.g. Custody, Visitation, Other)	 	Person	 (who filed the action)	 	State	 	
Court 	Case Number	 	Date Filed	 	
Result	 	Date of Order	 	
ACTION 3 	
Type of Action	 (e.g. Custody, Visitation, Other)	 	Person	 (who filed the action)	 	State	 	
Court	 	Case Number	 	Date Filed	 	
Result	 	Date of Order	 	
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F	
orm 346 
Rev. (01/13)	
 	
7. C	

heck ONE and complete as dire cted.	
I do not know of any other court action such as, Protection From Abuse, Termination of Parental 
Rights, Guardianship, Adoption or Paternity involving myself, the other party or the child(ren) that 
could affect this petition.  
I, the other party or the child(ren) have been and/or are currently involved in another court action 
such as, Protection From Abuse, Termination of Parental Rights, Guardianship or Adoption, that 
could affect this petition.  If you check this box, complete the information below. Attach additional 
sheets if necessary.  	
ACTION 1 	
Type of Action	 (e.g.	 PFA	, TPR	, Guardianship, Other	) 	Person	 (who filed the action)	 	State	 	
Court	 	Case Numb	er 	Date Filed	 	
ACTION 2 	
Type of Action	(e.g. PFA, TPR, Guardianship, Other)	 	Person	 (who filed the action)	 	State	 	
Court	 	Case Number	 	Date Filed	 	
Petitioner	 	
Sworn to subscribed before me this ______ day of ______________________, _________	 	
Clerk of Court/	Notary Public	 	
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1  of  2 	
Form 240  
Rev  10/13 	
The Family Court of the State of Delaware  	
INFORMATION SHEET - PLEASE PRINT  	
 Date:	 	File No.:	 	
Please fill in A to K pertaining to you the Applicant (Petitioner).  
A. Name:	 	
B. Ad	dress:	 	
    	City/State/Zip:	 	  	
C. Phone 	– Home: 	 	 	Work:	 	Cell:	 	
D. Employer & Address:	 	
    	Hours/Shift	 	
E. Social Security No.:	 	F. Date of Birth:	 	
G. Sex:	 	  	Race:	 	   	Height:	 	 	Weight:	 	    	Hair:	 	Eyes:	 	
Marks/Scars/Tattoos:	 	 	
H. Type of motor vehicle operated by you:	 	 	
I. Driver’s License No.:	 	State of Issue:	 	Expiration Date:	 	
J. Your relatio	nship to the Defendant/Respondent:	 	
K. Attorney	: 	 	
Please fill out the information below in reference to the child(ren) who are involved.  	
Children 	
Name	 	Relationship	 	Sex	 	Race	 	D.O.B.	 	Social Security No.	 	
O	

VER

Form 240 
Rev  10/13 
Please fill in L to X  pertaining to the Defendant/Respondent..(For additional  respondents use additional sheets)  
L. Defendant/Respondent is a: (Check One)      	 ADULT       	 JUVENILE  	
M. Name:	 	 	
N. Address:	 	
    	City/State/Zip:	 	  	
O. Phone 	– Home: 	   	Work:	 	Cell:	 	
P. Employer & Address:	 	
     	Hours/Shift	 	
Q. Social Security No.:	 	R. Date of Birth:	 	
S. Sex:	 	  	Race:	 	Height:	 	Weight:	 	Hair:	 	Eyes:	 	
Marks/Scars/Tattoos:	 	
T. Driver’s License	  	
     	State & 	No.:	 	
U. T ype 	of 	vehicle operated by 	
Defendant/Respondent	: 	
V. Parent’s Name (if a juvenile)	: 	 	
W. Time when Respondent is usually home	: 	
X. Any additional information about Respondent that  may aid the process server in locating him/her to serve this 
petition:  
 ________________________________________________________________________\
____________________________ 	
DIRECTIONS TO RESPONDENT’S RESIDENCE	 	
  2  of  2

F	
orm 156 
(Rev.  06/10) 	
The Family Court of the State of Delaware  	
In and For 	 New Castle  	 Kent  	 Sussex County  	
In the Matter of	: 	
)
)
)
)
)
)
)
)	
     	File No.:	 	
(D.O.B)	 	
ADO	

PTION  AFFIDAVIT OF EXPENSES 	
I, 	, attest that I have paid the filing fee to Family 	
Court for the filing of this Adoption Petition. I have not paid any other fees as of yet.	 I, 	
,further att	est that no intermediary assisted in locating this child.	 	
Sworn to subscribed before me this ______ day of ______________________, _________	 	
Clerk of Court	/Notary Public	 	
Date	 	Petitioner	 	
Page 1 of  1

F	
orm 110A  
Dev 11/13 	
The Family Court of the State of Delaware  	
In and For 	 New Castle  	 Kent  	 Sussex County  	
In the Matter of	: 	
)
)
)
)
)
)
)
)	
(DOB)	 	File No.:	 	
(DOB)	 	
(DOB)	 	
ADO	

PTION ORDER OF REFERENCE  	
Having considered the request of the movant,        
I

T IS SO ORDERED, this date:  
The foregoing Petition for Adoption having been presented to the Court, and it appearing that the 
Petition has been properly filed;  
It is ordered that the      
perform  a Social Study and submit a report to the Court as required by 13  Del. C.	, § 912. 	
Judge

F	
orm 159 
(Rev.  06/10) 	
The Family Court of the State of Delaware  	
In and For 	 New Castle  	 Kent  	 Sussex County  	
In the Matter of	: 	
)
)
)
)
)
)
)
)	
     	File No.:	 	
(D.O.B)	 	
A	

FFIDAVIT OF CONSENT OF  CHILD 14 YEARS OF AGE or OLDER 	
I, 	, hereby give my consent for 	 	
to adopt me.  I am 14 years of age or older.	 	
Affiant	 	
Sworn to subscribed before me this ______ day of ______________________, _________	 	
Clerk of Court	/Notary Public	 	Date	 	
Date	 	Consenting Party	 	
Page 1 of  1

IMPORTANT INFORMATION REGARDING THE FILING 	
OF A MOTION	 	
P
resenting a motion before the Court requires the completion and 
filing of three separate documents.  
The

 Generic Motion document (Form 191) must be filed along with 
the Notice of Motion (Form 192) and Form of Order (Form 193) 
documents.

Form 191 
Rev 1 2/1 3 	
The Family Court of the State of Delaware  	
In and For 	 New Castle  	 Kent  	 Sussex County  	
MOTION FOR	 	
Petitioner    Respondent 
   Name	 	   Name	 	File Number	 	
   Street Address	 (including Apt)	 	   Street Address	 (including A	pt)  	
   P.O. Box Number	 	   P.O. Box Number	 	Petition Number	 	
   City/State/Zip Code  	   City/State/Zip Code	 	
   Date of Birth	 	   Date of Birth	 	
  Attorney Name 	 Attorney Na	me 	
Interpreter 	needed?  	 Yes  	 No	Interpreter 	needed?  	 Yes  	 No	 	Language  	Language  	
A PROCEEDING involving	 	 	having been filed heretofore in this Court,	 	
Movant hereby moves the Court for	 	  	and, in	 	
support thereof, alleges the following facts:	 	
SWORN TO AND SUBSCRIBED	 	
before me this date,	 	
Movant/Attorney	 	
Clerk of Court/	Notary Public	 	
I, the Movant, affirm that a true and correct copy of this Motion was placed in the U.S. Mail on this date  	
, and sent to the other party or atto	rney at the address listed on the petition, being	 	
, first class postage 	 	
pre-paid.  
SWORN TO AND SUBSCRIBED	 	
before me this date,	 	
Movant/Attorney	 	
Clerk of Court/	Notary Public

Form 192 
R ev 1 0/10 	
The Family Court of the State of Delaware 	
In and For 	 New Castle  	 Kent  	 Sussex County  	
) 	
, 	) 	
Petitioner	 	) 	     	File	 No.:	 	
 v. 	)
)	     	Petition No.:	 	
, 	) 	
Respondent	 	)
)
)	
NOTICE OF MOTION	 	
TO:     
PLEASE TAKE NOTICE that the attached Motion for	 	  	
is herewith presented to the Court for consideration.  If you are opposed to this motion, you must 
file a written response with the Court within ten (10) days of the service of this motion.  If no 
response is timely filed, the motion may be decided without further opportunity for you to be heard 
on the matter.  Family Court Rules, Rule 7(b)( 2). 
Dated: 	
Movant/Attorney	 	
   Name and address of Movant/Attorney	 	
   Street Address	 (including Apt)	  	
   P.O. Box Number	 	
   City	/State/Zip Code

Form 193 
Rev 1 2/1 3 	
The Family Court of the State of Delaware  	
In and For 	 New Castle  	 Kent  	 Sussex County  	
) 	
, 	) 	
Petitioner	 	) 	     	File No.:	 	
 v. 	)
)	     	Petition No.:	 	
, 	) 	
Respondent	 	) 	     	In Re:	 	  	
)
)	
ORDER	 	
Having considered the request of the movant,	 	, 	
IT IS SO ORDERED	, this date:	 	
That 	
Judge/Commissioner	 	
CC: 	 Petitioner 	 Respondent 	 Petitioner Attorney 	 Respondent Attorney 	 DAG 	 PD 	
Other	       	 DCSE

Form 192i 
(Rev.  05/11)	
The Family Court of the State of  Delaware 	
(1) In and For 	 New Castle  	 Kent  	 Sussex County  	
) 	
     	 (2)  ___	             )  File No.: __  (4) 	
P	

etitioner    ) 	
    ) 	
v.  ) P	 etition No.: (5) 	
) 	
     	 (3)  ___ 	) 	
R	 espondant  ) 
) ) 	
NOTICE OF MOTION	 	
T	

O:      (6)  	
P	LEASE TAKE NOTICE that the attached Motion   (7)                                               	 is 
herewith presented to the Court for consideration.  If you are opposed to this motion, you must 
file a written response with the Court within ten (10) days of the service of this motion.  If no 
response is timely filed, the motion may be decided without further opportunity for you to be 
heard on the matter.  Family Court Rules, Rule 7(b)(2).  	
      	 (8) 	
 P	 etitioner/Attorney 	
(9) 	(10)  	
Date	 	Movant/Attorney	 	
Name and address of Movant/Attorney	 	
Street Address	  	
P.O. Box Number	 	
City/State/Zip Code	 	
1 of  2

Form 192i 
(Rev.  05/11)	
FAMILY COURT FORMS INSTRUCTIONAL MANUAL  	
SU	

BJECT:  Form 192, Notice of Motion (Motion Package)  	
I.	

  Definition  	
For	

m 192 is one of two documents that must accompany a motion at the time it 
is filed in Family Court in accordance with Family Court Rule 7(b)(1).  Its purpose 
is to act as an informational cover sheet which the movant attaches to the copy 
of the motion that he/she is sending to the other party(ies) in the matter.  In this 
way, the other party(ies) are notified that a motion has been filed in Family Court 
on a matter in which they have an interest.  	
II.P	

reparation	
For	

m 192 is prepared by the movant, or party filing the motion.  The original is
submitted along with the motion (Form 191) and the form of order (Form 193) at
the time of the filing of the motion in Family Court.  It is the responsibility of t	
he	
m	

ovant to  send a copy of all three forms, completed as appropriate, to the other
party(ies).  Once it has been filed with the Court, the motion package is sent t	
o	
C	

ase Processing and then to a judge/commissioner for review.  The notice of
motion must be served according to Family Court Civil Rule 5(c).	
III. C	

omponents	
T	

he following is entered in the appropriately numbered area(s):	
1. A	

n "x" to indicate the appropriate county of the Court.	
2. T	

he name of the petitioner.	
3. T	

he name of the respondent.	
4. The Fam	

ily Court file number (if known).	
5.T	

he Family Court petition number (if known).	
6. T	

he names and addresses of the parties to the case and of their
attorneys, if applicable.	
7. T	

he type of motion being filed.	
8. T	

he signature of the attorney/party filing the motion.	
9. T	

he date that the motion is being filed.	
l0	

.   The name and address of the attorney/party filing the motion.	
2 of  2

Family Court	 	 
F	
orm 405 
(Rev  01/12) 	
The Family Court of the State of Delaware  	
In and For 	 New Castle  	 Kent  	 Sussex County  	
Petitioner    Respondent 
   Name	 	   Name	 	     File Number	 	
   Street Address	 	   Street Address	  	
   P.O. Box Number	 	   P.O. Box Number	 	    Petition Number	 	
   City/State/Zip Code	 	   City/State/Zip Code	 	
   Date of Birth	 	   Date of Birth	 	
e   Attorney Name 	  Attorney Name 	
AFFIDAVIT OF NON- MILITARY SERVICE 	
STATE OF DELAWARE	 	)
)	     	ss.	 	
COUNTY	 	) 	
BE IT REMEMBERED, that on this date,	 	      	, personally appeared	 	
before me, a Notary Public for the State of Delaware in the County declared above,  	
, (“Affiant”), who, being duly sworn by me according to law,	 	
did depose and say: 	
1.T	

hat Affiant is the Petitioner in the above captioned civil action;	
2.T	

hat Respondent is not in the military service of the United States of America; and	
3.T	

hat Affiant has made this Affidavit pursuant to the provisions of § 521 of the
Servicemembers Civil Relief Act (50 USCS App. § 501 et seq)	
  Affiant  	
Clerk of Court/Notary Public  	
SWORN TO AND SUBSCRIBED before me this date,