San Joaquin — Declaration of Custodial Parent

San Joaquin — Declaration of Custodial Parent (PDF)¶

ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, Address, and Telephone No.): FOR COURT USE ONLY

ATTORNEY FOR:

SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN JOAQUIN 180 East Weber Avenue, Suite #413 Stockton, CA 95202

IN THE MATTER OF THE ADOPTION PETITION OF:

(Name of Adopting stepparent/domestic partner)

on behalf of (Name of Minor/s):

DECLARATION OF CUSTODIAL PARENT CASE NUMBER:

I, , make the following statement in connection with the adoption plans

for my child.

The child’s name:

Date of birth: Place of birth: (day, month, year) (city, state)
I believe that the non-custodial parent of the child is: (name, including any aliases)

(If more than one person may be the child’s birth father; please provide the following information for each

person whom you believe to be the child’s birth father.)
The non-custodial parent lives at: (street address, city, state) (If present address unknown, give any known past addresses.)
S/he works for: (employer’s name and address)

as a (position or type of work)

Give the names and address of any past employers, if known:
Is s/he in school? Yes No Don’t Know

If yes,
(name of school, city, state)
Is s/he in the armed forces? Yes No Don’t Know

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If yes, what branch is s/he in and where stationed?

Do you know where or when the non-custodial parent was born? Yes No Don’t Know

If yes, date: Place of birth
(day, month, year or age) (city, state)
Is the non-custodial parent married? Yes No Don’t Know
Has a court ordered the non-custodial parent to help support the child? Yes No Don’t Know

If yes, which court, when, and in what amounts?
Has s/he promised you in writing to help support the child? Yes No

If yes, explain:
Have you ever refused to take money or items to help with child support expenses from the non-custodial

parent? Yes No

If yes, explain:
Has the non-custodial parent ever written to, spoken to, or visited with the child? Yes No

Don’t Know If yes, what did s/he do, when, and how many times (state in numbers):
Have you ever refused to let her/him write to, speak to, or visit with the child? Yes No Don’t Know

If yes, explain:
Has s/he offered to take the child into his/her home? Yes No Don’t Know
Has the birth father ever acknowledged that he is the father of the child? Yes No Don’t Know

If yes, when, where, and in what manner?
Did you and the other parent sign a Voluntary Declaration of Paternity? Yes No

If yes, when and where was the declaration signed?
Has a paternity test been administered to the child and any possible fathers? Yes No

If yes, who administered the tests and what were the results?

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Has the child ever lived with the non-custodial parent rather than with you? Yes No

If yes, give dates: From: to:
Has any legal action been brought to determine custody/paternity of the child? Yes No

Don’t Know If yes, who brought the action, where, and when?
Have you discussed adoption of the child with the non-custodial parent? Yes No
Do you think s/he would agree to an adoption if that is what you wished? Yes No Don’t Know
The identity of the birth father/mother of the minor child is unknown to me because
I am unable to identify the birth father/mother of the minor because
Other information:

I understand that this information is given to assist the court in the investigation of the Petition to Declare Minor Free

and Terminate Parental Rights. I declare under penalty of perjury under the laws of the State of California that the

foregoing is true and correct.

Executed at on (city, state) (date)

SIGN

(Signature of Declarant) (Address of Declarant)

Witness:

SIGN

(Printed name of person who witnessed signature) (Signature of person who witnessed signature of declarant)

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