Marin — FL022

Source: https://www.marin.courts.ca.gov/system/files/fl022-petitiontodeclarechildfreefromcustodyn7-15n.pdf

ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, address and telephone #): FOR COURT USE ONLY

STATE BAR NO: ATTORNEY FOR (Name):

MARIN COUNTY SUPERIOR COURT 3501 Civic Center Drive P.O. Box 4988 San Rafael, CA 94913-4988 IN THE MATTER OF THE PETITION OF:

ON BEHALF OF: A CHILD, PETITION TO DECLARE CHILD FREE FROM CASE NUMBER: PARENTAL CUSTODY AND CONTROL (Family Code Section 7822)

1. Petitioner is an adult person and desires to adopt _____________________________ (name of child), a child who is the subject of this petition. Petitioner is the spouse of __________________________ (name of parent) who is the father mother of the child and who has custody of the child. Petitioner, Petitioner’s spouse, and the child reside in Marin County, California.

2. The minor child has been left by ______________________ (name of absent parent) the natural father mother in the custody and control of ______________________ (name of person) who is the father mother other ______________________ (specify) of the child.

3. The father mother has not communicated with the minor child since __________ (year), a period of over one year or the father mother has not made any provisions for the support of the minor since ___________ (year), a period of over one year.

Wherefore, petitioner requests an order declaring that the child is free from the custody and control of father mother.

I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.

DATE

PRINT NAME SIGNATURE OF PERSON COMPLETING THIS FORM

FL022 PETITION TO DECLARE CHILD FREE FROM PARENTAL CUSTODY AND CONTROL Rev. 7/9/15 (Family Code § 7822)