Amador — ADOPT-230

Source: http://www.courts.ca.gov/documents/adopt230.pdf

Clerk stamps date here when form is filed. ADOPT-230 Adoption Expenses

If you are adopting your stepchild, do not fill out this form.

1 a. Your name (adopting parent or parents): (1) (2) b. Address (skip this if you have a lawyer): Street: City: State: Zip: Fill in court name and street address: Superior Court of California, County of c. Telephone number: d. Lawyer (if any): (Name, address, telephone number, and State Bar number):

Fill in case number if known:
Check this box if there are more adopting parents. Use a separate Case Number:
piece of paper and write “ADOPT-230, Other Adopting Parents” at
the top and complete a–d. Turn it in with this form.

2 Name of child after adoption:

3 List services you received that were related to the adoption of the child listed in 2 . Include all medical, hospital, attorney, legal fees and costs, doctors and physicians, surgeons, licensed adoption agency, or any other person or organization that received payment in connection with the birth of the child, expenses, and services received by either birth parent or by the child. (Examples of other services provided: prenatal care, transportation, counseling, adoption service provider, pregnancy expenses, court filing fees, fingerprinting fees.) Name and address of How much paid, or Service service provider value of service Payment date

a. $

b. $

c. $

d. $

Judicial Council of California, courts.ca.gov ADOPT-230, Page 1 of 2Rev. July 1, 2025, Mandatory Form Adoption Expenses Family Code, § 8610

Case Number: Adopting parent or parents:

Name and address of How much paid, or
Service service provider value of service Payment date

e. $

f. $

g. $

h. $

i. $

j. $

k. $

l. $

Check this box if you need more space to list the services related to this adoption. Use a separate piece of paper
and write “ADOPT-230, Item 3—Payment for Services” at the top and include the service, name and address
of provider, amount paid, and payment date. Turn it in with this form.
Number of pages attached:

4 I declare under penalty of perjury under the laws of the State of California that I have listed all payments (or anything of value) that I have paid or agreed to pay, or that were paid on my behalf, related to the child I want to adopt. I declare under penalty of perjury under the laws of the State of California that the information in this form is true and correct, which means that if I lie on this form, I am guilty of a crime.

Date: Type or print your name Signature of adopting parent

Date: Type or print your name Signature of adopting parent

Date: Type or print your name Signature of adopting parent

Rev. July 1, 2025 Adoption Expenses ADOPT-230, Page 2 of 2 For your protection and privacy, please press the Clear This Form button after you have printed the form. Print this form Save this form Clear this form