PACKET “Q” Step-Parent Adoption

PACKET “Q” Step-Parent Adoption

[Begin by filling out Sensitive Data Form]

_____ Form 275. Affidavit of Inability to Pay _____Form 276. Petition for Step-Parent Adoption _____Form 277. Parent’s Consent to Step-Parent Adoption _____Form 278. Parent’s Consent to Step-Parent Adoption & Relinquishment of Parental Rights _____Form 279. Child’s Consent to Step-Parent Adoption (if child is 12

years or older) _____Form 280. Request for Hearing on Petition for Step-Parent

Adoption & Order Setting Hearing _____Form 281. Step-Parent Adoption Decree _____Form 282. Notice to CSED to Terminate Child Support Obligation

Form 283. Vital Statistics Form

(Revision Date: 5/16)

DISCLAIMER

These documents do not constitute legal advice, and no information contained in these documents can be relied upon to replace the advice of competent legal counsel licensed to practice in Montana.

Instructions for Packet Q - Pro se Step-parent Adoption Page 1 of 3 (Revision Date: 5/16)

INSTRUCTIONS FOR STEP-PARENT ADOPTION (PRO SE)

A. The Petition (Form 276) 1. The “Petitioner” is the step-parent of the child or someone the custodial parent

consents to adopt the child – it is not the biological parent.

2. If more than one child is being adopted by the step-parent, then a separate Petition and a separate Consent Form is needed for each child.

3. The Clerk will assign a Dept. Number and a Cause Number to your case at

the time you file. You will need to put those numbers on all other documents you file in your case.

4. The filing fee is $105 for adoptions. If you cannot afford the filing fee,

complete Affidavit of Inability to Pay (Form 275), and the judge may waive the fee.

B. Custodial Parent’s Consent

1. The biological parent with whom the child lives (who is often the Petitioner’s

spouse) must complete the Consent to Adoption (Form 277) and sign in front of a notary.

2. If the child is age 12 or older, their consent is also required.(Form 279)

C. Other Parent’s Consent

1. The other biological parent, the one who is relinquishing his/her rights to the child and consenting to the adoption, should complete Form 278 and sign in front of a notary.

NOTE: If the other parent’s parental rights have already been terminated by a Court Order, or that parent is no longer living, then you will not need this form. ALSO: If Petitioner is unable to locate the other parent, the Petitioner must use his or her best efforts to get the other parent’s consent by serving the other parent at their last known address(es). If the Petitioner still cannot locate the other parent, the Petitioner may file a motion for service by publication in a newspaper where the other parent was last known to be residing.


FILING YOUR PAPERWORK

1. File the Petition and Consent Forms (originals) with the Court. Keep a copy

for your records.

D. Request for Hearing 1. Complete the Request for Hearing (and the second page with the proposed

Order) (Form 280) asking that your adoption be placed on the court calendar for a final hearing.

2. File the original and a copy of the Request for Hearing along with a stamped, self-addressed envelope so that the Order setting the hearing can be mailed back to you when your case is placed on the calendar (or request that the Clerk email you copies of your documents)

3. Complete the Vital Statistics Form (Form 283) and the Step-Parent Adoption

Decree (Form 281) to submit along with the Request for Hearing.

E. Adoption Decree 1. Complete the Step-Parent Adoption Decree (Form 280) and make 2 copies.

2. File the original. Once the Judge signs the Decree, you will be able to obtain a

copy from the Clerk of Court after you pay the final filing fee.

F. Order Terminating Child Support Obligation 1. Complete the Order Terminating Child Support Obligation (Form 282) if

there is an open Child Support Order.

2. File the original. Once the Judge signs the order, you will able to obtain a copy from the Clerk of Court. You must send a certified copy to CSED

Mailing Address: Montana D.P.H.H.S. Child Support Enforcement Division 2675 Palmer Street – Suite C Missoula, MT 59808


FINAL HEARING 1. Be at the Courthouse 15 minutes early on the day of the hearing. Adoptions

are “sealed” so your hearing will be closed to the public.

2. The Petitioner, the spouse of Petitioner (who is the biological parent of the child), and the child who is being adopted all attend the hearing. Feel free to invite grandparents and siblings and other important people in the child’s life to attend the hearing. Bring a camera if you like.

3. At end of the hearing, the judge will sign the Final Decree and will give you the

court file to take to the Clerk of Court to complete the paperwork. The clerk will need a $25 check made out to the Department of Vital Statistics for a child born in Montana. Unless you have a fee waiver, you will also have to pay for certified copies of the Final Decree and Petition which the Clerk will send to Helena. In about a month you will receive a new or substitute birth certificate from Montana.

4. If the child was born in another state, you will need to find out the name and

address of the department that handles birth certificates in that state, along with whatever fee is charged and send your paperwork to them for the new birth certificate.

Sensitive Data Form – Step-Parent Adoption Page 1 of 2 4th Judicial District Forms - Pro se Parenting (Revision Date: 05/16)

_______________________________ Name _____________________________________ Address _____________________________________ City State Zip Code _____________________________________ Phone Number PETITIONER MONTANA FOURTH JUDICIAL DISTRICT COURT MISSOULA COUNTY

In re the Adoption of: ____________________________________, Minor Child. ____________________________________, Petitioner,

Cause No.: _________________ Department No. _____________

SENSITIVE DATA FORM “CONFIDENTIAL”

Pursuant to the Privacy and Access rules of the Montana Supreme Court (AF 06-0377) sensitive data should not be filed or included in a case record, except on this form. Sensitive data is defined as social security numbers, bank account numbers, credit card numbers, other financial account numbers, and dates of birth for the parties and any minor children (unless required to be made public by law). The Clerk will secure this form separately from other case records and will prohibit access to this information except as provided by Section 4.60(c) of the Rules on Public Access to Court Records (available at www.courts.mt.gov). Information on Petitioner - (Full Legal Name)

Full Date of Birth

Social Security Number

Sensitive Data Form – Step-Parent Adoption Page 2 of 2 4th Judicial District Forms - Pro se Parenting (Revision Date: 05/16)

Information on Financial Accounts (that are listed under “assets and debts” in court documents):

Code Name: (Last 4 digits)

Financial Account Description (type of account and name on account)

Financial Institution Account Number

FA #

FA #

FA # Information on Child:

Name: Full Legal Name Date of Birth Age M/F

DATED this _______ day of ____________________, 20___. _____________________________________ Petitioner

FORM #275 – AFFIDAVIT OF INABILITY TO PAY FILING FEE AND OTHER COSTS AND ORDER 4th Judicial District Forms - Pro se Step-Parent Adoption (5/16)

_____________________________________ Name _____________________________________ Address _____________________________________ City State Zip Code _____________________________________ Phone Number _____________________________________ Email Address

MONTANA FOURTH JUDICIAL DISTRICT COURT, MISSOULA COUNTY

IN RE THE ADOPTION OF: ______________________________________. Minor Child. ______________________________________, Petitioner.

Dept. _______ Cause No. ______________________ AFFIDAVIT OF INABILITY TO PAY FILING FEES AND OTHER COSTS

[WRITE CLEARLY -- ANSWER ALL QUESTIONS. USE N/A IF NOT APPLICABLE.]

STATE OF MONTANA ) :ss. COUNTY OF ______________ ) I, ______________________________________________________________, (Your Name) 1. I have a good cause of action or defense and am unable to pay the costs. 2. I request that the Court issue an order waiving prepayment of my fees. 3. I understand the court may order me to answer questions about my finances. 4. I understand if the court waives my fees, I may still have to pay later if I cannot

give the court proof of my financial eligibility or if my financial situation improves before this case is over.

I am: Single________ Married________ Divorced________ Separated________ 5. I am asking the court to waive my fees because I receive (check all that apply):

□ SSI $_________________ □ Food stamps $_________________ □ TANF (Welfare) $_________________

FORM #275


□ Medicaid $_________________

AND/OR □ The gross monthly income for all household members (before deduction for taxes) that Isupport or who help support me is less than listed in the table below. I am including allsources of income (such as child support, benefits, unemployment, dividends, interest,business rental income, etc.) [Mark the box below that describes your household sizeand income.]

□ I am the only person living in my household and I make less than $1,128.00 a month.

□ There are (2) people living in the household and together we make less than $1,517.00/month.







Are persons dependent on you for support? Yes_______ No_______ If yes, list each person and that person's age and relationship to you:

□ I have unusual medical or care expenses or am experiencing an emergency (describe):

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________


EMPLOYMENT INFORMATION Employed: Yes_____ No_____ Self-Employed: Yes_____ No_____ Hourly wage $__________ Hours you work per week___________ Type of employment______________________ Length of current Employment____________ Employer's name and address__________________________________________________

Is there any reason, such as disability, family responsibilities, or pursuit of an education, that prevents you from being able to work full-time?

__ Yes, please explain: __________________________________________________. __ No. Note: You may be asked for documentation before the court makes a decision on granting your request to waive the filing fees. If unemployed: Month/Year last employed_____________________ Last hourly wage $_________________ Why did you leave your last employment?________________________________________________________________ ASSETS REAL ESTATE Do you or your spouse own or are you or your spouse buying any land or other real estate? Yes________ No_________ If yes, what is the approximate current market value? $______________________________ What was the purchase price? $________________________________________________ When did you purchase the land or other real estate? _______________________________ Is it paid for? Yes________ No_________ If not, how much do you or your spouse owe on the land or other real estate? $___________________________ FINANCIAL ACCOUNTS: Do you or your spouse have: Checking accounts? Yes_________ No_________ If yes, total amount $________________ Savings accounts? Yes_________ No_________ If yes, total amount $_________________ List the banks where the accounts are held: _______________________________________ ___________________________________________________________________________ Do you or your spouse have stocks or bonds? Yes__________ No__________ If yes, what is the total amount of the stocks or bonds $______________________________ Do you or your spouse have wages due but not received? Yes________ No _________ If yes, list total amount $___________________________________ Is there money owed to you or your spouse? Yes__________ No__________ If yes, total amount owed to you or your spouse $______________________ ___________________________________________________________________________ ___________________________________________________________________________


MOTOR VEHICLES: (You must check one box)

□ I do not own my own vehicle□ I own vehicle(s) as listed below:1. ___________________________ Year Make Model Value $__________________ Loan Balance $__________________ Monthly Payment $__________________

2. ___________________________ Year Make Model Value $__________________ Loan Balance $__________________ Monthly Payment $__________________



PERSONAL PROPERTY: Value of your or your spouse's personal property:

Sporting Equipment $______________ Guns $______________

Boats $______________ Trailers/Campers $____________

Tools $______________ Electronics $____________

Furniture $__________________ Appliances $____________

Other personal property $_______________ ATV/motorcycles $____________

Describe and value other personal property you or your spouse own or are buying:

______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________


MONTHLY EXPENSES List you or your spouse's monthly expenses: Rent $_________ House Payment $____________ Food $_________ Clothing $____________ Phone $_____________ Utilities: Water $_________ Gas $____________ Electric $_____________ Insurance: Health $_________ Auto $____________ Electronic: Cable $_________ Satellite TV $________ Internet $_____________ Other (List each item):

1. __________________________________ 2. ___________________________________

3. __________________________________ 4. ___________________________________

DEBTS: Credit Card Debt $______________ Medical Debt $______________ --Describe: _________________________________ ___________________________________________________________________________ Other (List each item):

1. __________________________________ 2. ___________________________________

3. __________________________________ 4. ___________________________________

Please complete the following: _____I prepared all of the pleadings and papers to be filed in this case myself, and no one has

been, or will be, paid on my behalf. I have not paid anyone or any organization for the preparation and processing of these documents or for the forms to be used in this case.

_____I further declare that I am the person above named, that I have read the foregoing questions and information and know the same to be true to the best of my knowledge, and that IF ANY PART OF THE ABOVE IS MADE FALSELY, I AM SUBJECT TO PROSECUTION FOR PERJURY.

________________________________________ (Signature of Affiant) SUBSCRIBED AND SWORN TO before me, a notary public, this _______ day of _______________________, 20_______. ________________________________________ Notary Public for State of Montana Residing at_______________________________ My Commission Expires:_________________


Hon. ___________ Fourth Judicial District Missoula County Courthouse 200 West Broadway Missoula, Montana 59802 (406) 258-4780 Fax (406) 258-4899

MONTANA FOURTH JUDICIAL DISTRICT COURT, MISSOULA COUNTY

IN RE THE ADOPTION OF: ______________________________________. Minor Child. ______________________________________,

Petitioner.

Dept. No. Cause No.: DA-

ORDER ON INABILITY TO PAY FILING FEES AND

OTHER COSTS

Having considered the information contained in Mother’s/Father’s (circle one)

Co-Petitioner’s Affidavit of Inability to Pay Filing Fees and Other Costs, IT IS

HEREBY ORDERED that, pursuant to §25-10-404, MCA et seq., all officers of

the Court shall perform all services associated with this action, including filing,

issuance and service of all pleadings and court orders, without demanding or

receiving fees in advance. Leave to file the Petition expires thirty (30) days from

the date of this Order.

Dated this ______ day of ____________________, 20 ___.

__________________________________

DISTRICT COURT JUDGE

FORM #276 – PETITION FOR STEP-PARENT ADOPTION Page 1 of 5 4th Judicial District Forms - Pro se (Revision Date: 5/16)

_____________________________________ Name _____________________________________ Address _____________________________________ City State Zip Code _____________________________________ Phone Number _____________________________________ Email Address PETITIONER, PRO SE

MONTANA FOURTH JUDICIAL DISTRICT COURT MISSOULA COUNTY

IN RE THE ADOPTION OF:

____________________________, a Minor Child.

____________________________, Petitioner.

Cause No.: DA - __________

Department No. _____

PETITION FOR STEP-PARENT ADOPTION

Comes now the Petitioner, ____________________________, and states (your name)

the following:

I would like to adopt my stepchild whose name is: ___________________.

1. Petitioner’s information:Name: _______________________Address: _______________________

_______________________ _______________________

FORM # 276

FORM #276 – PETITION FOR STEPPARENT ADOPTION Page 2 of 5 4th Judicial District Forms - Pro se (Revision Date: 6/11)

How long have you lived at this address? _______________ Your Age: ______________ 2. Marital Status: I am currently married to: ____________________________ We were married in: ________________________________ (City) (State) On the following date: _____________ (mm/dd/yyyy) 3. Child’s Information: Full Name: ________________________________________ Birthplace: ________________________________________ (City) (State) Birthdate: ________________________ (mm/dd/yyyy): 4. The child lives with: _________________________________,

who has legal and physical custody of the child. The child has lived with this parent since: _______________

Check if applicable: A parenting plan or custody agreement regarding this child

was entered on_________________________in the County of (mm/dd/yyyy)

__________________, State of __________________. 5. Child’s Relationship to Me My spouse is the Mother/ Father of the child. The child has

lived with and been in my physical custody since: __________________________

(mm/dd/yyyy) 6. My Spouse’s Consent My husband’s / wife’s consent to my adoption of the child is

attached to this Petition.


7. The Other Parent Choose One: The child’s other parent has relinquished his/her parental rights

and consents to my adoption of the child. The other parent’s relinquishment and consent is also attached to this Petition. This other parent waives the right to notice and a hearing.

or The parental rights of the other parent have already been

terminated by Court order on: _____________________ by the (mm/dd/yyyy) ______________________ in ______________________, (name of court) (county) State of _____________________. A copy of the order is attached to the Petition. or The child’s other parent has died. The death certificate is

attached to the Petition.

or I have exercised diligent efforts to obtain the consent of the

child’s other parent by serving them a copy of the Petition at their last known address(es) and, if no response, I am requesting approval by the Court to publish notice of these proceedings in a local newspaper where they were last known to reside in Montana.

8. Child’s Name Change The child’s name should stay the same. The court should change the child’s name to: _______________________________________________. First Middle Last

FORM #276 – PETITION FOR STEPPARENT ADOPTION Page 4 of 5 4th Judicial District Forms - Pro se (Revision Date: 6/11)

9. Parent-Child Relationship I would like the court to establish a parent-child relationship between

me and the child. I would like to have all the duties, responsibilities, and legal consequences of the parent/child relationship.

10. Child’s Property Choose One: The child does not own any property of value. or A complete statement of the value of all property owned or

possessed by the child is attached to this Petition. 11. Post-Placement Evaluation This is a stepparent adoption. It is in the child’s best interests to

waive the post-placement period and evaluation. A final decree of adoption should be entered at the time of hearing.

12. Controlling Law I have followed any laws controlling this adoption. The child is not an

enrolled member of a tribe or a tribal descendent and does not have any other tribal affiliation. The Indian Child Welfare Act does not apply. I have not filed any petition before this one to adopt this child. I believe this adoption is in the child’s best interests.

13. Notice Both parents have consented to this adoption and/or best efforts have

been made to notify the other parent. No other party is entitled to receive notice of this Petition.

I respectfully ask this Court to: 1. Schedule a hearing to decide this matter; 2. Waive the post-placement period;


3. Terminate the parental rights of the non-custodial parent if he or she has not responded;

4. Grant me a final decree of adoption of the child; and 5. Change the child’s name if requested.

VERIFICATION Petitioner, _______________________, affirms that he or she has

read the foregoing Petition for Step-Parent Adoption. Under penalty of

perjury, Petitioner certifies by his or her signature below that all of

Petitioner’s statements contained in the foregoing Petition for Step-Parent

Adoption are true, accurate and complete to the best of Petitioner’s actual

knowledge. As to any statements for which Petitioner lacks actual

knowledge, Petitioner believes those statements to be true, accurate and

complete based on information and belief.

DATED this ____ day of _____________, 20__. _______________________________ Petitioner SUBSCRIBED AND SWORN to before me this ______ day of ___________,

20_____. STATE OF MONTANA ) : ss. County of _______________) ____________________________________ Notary Public for the State______________ Printed name of notary_________________ SEAL Title or rank _________________________ Residing at__________________________ My Commission Expires_______________

FORM #277 – Custodial PARENT’S CONSENT TO STEP-PARENT ADOPTION Page 1 of 3 4th Judicial District Forms – Pro Se Step-Parent Adoption (Revision 05/16)

_____________________________________ Name _____________________________________ Address _____________________________________ City State Zip Code _____________________________________ Phone Number _____________________________________ Email Address PETITIONER, PRO SE


In re the Adoption of : ___________________________, Minor Child. ___________________________, Petitioner (Step-parent).

Dept. No.: ________________ Cause No.: DA-____________ PARENT’S CONSENT TO STEP-PARENT ADOPTION

I am the Petitioner’s spouse or ______________. I declare, under penalty of perjury, that the following information is true and correct:

1. My full name is: _______________________________.

2. I am the Mother/ Father other:____________ of

__________________________. Minor Child’s Name

3. I declare the following statements, under penalty of perjury for the purpose of consenting to adoption of my biological child: ______________________________, was born on ______________,

Minor Child’s Name date ____________.

4. The child lives with me. I have legal and physical custody of the child.

Form 277


5. I have received and reviewed a copy of the Petition for Step-ParentAdoption (“Petition”) filed by ______________________, in the above-captioned matter. I affirm that I have read and that I understand anddo agree with all of the allegations in the Petition.

6. I affirm that the child is not affiliated with any tribe, is not a tribalmember or tribal descendent.

Choose one:

7. I affirm that, __________________, is the biological parent of thechild, and has consented to the adoption of the child by the Petitioner.The other parent acknowledged his/her understanding that thisadoption will terminate all his/her parental rights to the child, andterminate their obligation to support the child.

or

The other parent has abandoned and/or cannot be found and diligent effort has been made to provide notice to him/her of these proceedings.

8. I affirm and understand that the adoption will end the parent-child relationship between the other parent and the child. I understand that the adoption will end any existing court orders for custody, visitation, or communication by the other parent and the child.

9. I affirm and understand that the adoption will not end my parent-child relationship with the child.

10. I affirm that a strong parenting relationship has grown between the child and the Petitioner, and that such relationship has grown with my consent. I believe that relationship has promoted and will be in the child’s best interests.

11. I want the Petitioner to adopt my child. My consent to the adoption is voluntary and unequivocal.

12. I affirm that the child, if age 12 or older, has expressed to me a strong desire to have a parent-child relationship with this step-parent.


13. I have discussed and considered the legal consequences of a parental

termination order and a step-parent adoption order. I am satisfied that

I understand the legal and practical consequences of such orders.

14. I affirm and understand that even after the adoption, the child will still

have rights to inherit from the other parent if the biological parent is no

longer living at the time of adoption. The child’s descendants (children,

grandchildren, etc.) will still have rights to inherit from the parent who

died prior to the adoption.

15. I voluntarily consent and affirmatively request that the Court enter an

Order terminating the parental rights of the child’s biological parent

__________________, and that such order be consolidated with an

order granting Petitioner the right, to adopt my child ____________.

Dated this ____ day of ______________, 20___.

Signed: _________________________________

STATE OF MONTANA ) : ss County of _______________ )

SUBSCRIBED AND SWORN to before me this ____ day of ________________,

20___.

__________________________________ Printed Name: ______________________

SEAL Notary Public for the State of ___________ Residing at __________________________ My Commission Expires_______________

FORM #278 – CONSENT OF PARENT TO STEP-PARENT ADOPTION Page 1 of 3 AND RELINQUISHMENT OF PARENTAL RIGHTS 4th Judicial District Forms - Pro se Stepparent Adoption (Revision Date: 05/16)

_____________________________________ Name _____________________________________ Address _____________________________________ City State Zip Code _____________________________________ Telephone Number _____________________________________ Email Address PETITIONER, Pro Se MONTANA FOURTH JUDICIAL DISTRICT COURT MISSOULA COUNTY

IN RE THE ADOPTION OF: ____________________________, Minor Child. ____________________________, Petitioner.

Dept. No.: ____ Cause No.: DA- __________

CONSENT OF PARENT TO STEP-PARENT ADOPTION AND RELINQUISHMENT OF

PARENTAL RIGHTS

I, ____________________________________, swear (or affirm) under oath that: 1. I am the biological:

[ ] mother of the above named minor.

[ ] father of the above named minor.

2. My information: Full Name: ______________________________ Date of birth: _______________ (mm/dd/yyyy)

FORM #278


Current mailing address: _____________________ _____________________ _____________________ 3. Child’s information: Full name: ___________________________________ Date of birth _____________________ (mm/dd/yyyy) 4. After considering my child’s best interests, I, ___________________,

am relinquishing or giving up all custody, care, and control of the child

to the child’s Mother Father, ______________________,

and stepparent, ________________________. By signing this, I know

that I am relinquishing or giving up all of my parental rights and

agreeing to the stepparent adoption. I am agreeing to the transfer of

permanent physical and legal custody to the Petitioner, ____________

and the adoption of the child by the Petitioner, ___________________.

6. I affirm and understand that after this document is signed, or confirmed

in substantial compliance with M.C.A. §42-2-412, it is final and, except

under a circumstance stated in M.C.A. §42-2-411, may not be revoked

or set aside for any reason, including the failure of the adoptive parent

to permit me to visit or communicate with the child.

7. I affirm and understand that this relinquishment will remove all parental

rights and obligations that I have with respect to the child, except for

arrearages of child support, and that this relinquishment will remain

valid whether or not any agreement for visitation or communication with

the child is later performed.

8. I affirm that I have received a copy of the relinquishment and consent to

adopt.


9. I voluntarily and unequivocally transfer permanent legal and physical

custody of the child to the Petitioner.

10. I voluntarily waive all parental rights of custody to the above-named

minor.

11. I have had access to and the ability to consult with an attorney prior to

signing this form. I understand that if I cannot afford an attorney, then I

may ask that the Court order the Petitioner (adoptive parent) to pay this

expense for me by filing a motion.

SIGNED: ________________________

DATED this ____ day of _________________, 20___ at ________ p.m./a.m.

STATE OF MONTANA ) : ss. County of _____________ )

SUBSCRIBED AND SWORN TO before me, a notary public, this _________ day of ________________________, 20____. ___________________________________ (Notary Seal) Notary Public for the State of Montana Printed Name: _______________________ Residing at __________________________ My Commission Expires________________

FORM #279 – CHILD’S CONSENT TO STEP-PARENT ADOPTION Page 1 of 2 4th Judicial District Forms - Pro se Guardianship (Revision Date: 05/16)

_____________________________________ Name _____________________________________ Address _____________________________________ City State Zip Code _____________________________________ Phone Number _____________________________________ Email Address PETITIONER, PRO SE MONTANA FOURTH JUDICIAL DISTRICT COURT MISSOULA COUNTY

In re the Adoption of: ____________________________, Minor Child. ____________________________, Petitioner.

Cause No.: DA- _________ Department No. _____ CHILD’S CONSENT TO STEP-

PARENT ADOPTION

I am the child named in the Petition for Step-Parent Adoption. I am

12 years of age or older. I declare, under penalty of perjury, that the

following information is true and correct:

1. My full name is: ______________________________

2. I live with my step-parent and my Mother / Father.

3. I want my step-parent to adopt me. This is my choice. No one has

made me agree to this adoption. I am completely sure that I want my step-

parent to adopt me.

FORM # 279

FORM #279 – CHILD’S CONSENT TO STEP-PARENT ADOPTION Page 2 of 2 4th Judicial District Forms - Pro se Guardianship (Revision Date: 05/16)

4. I would like my new name to be ________________________.

Date: _____________________ Signature: ________________________ (mm/dd/yyyy) Print Name: _______________________ STATE OF MONTANA ) : ss County of ___________________) This Consent to Step-parent Adoption was acknowledged before me on ____________, by ____________________________. (mm/dd/yyyy) Parent’s Name ____________________________________ Name (printed): _______________________ SEAL Notary Public for the State of Montana Residing at__________________________ My Commission Expires_______________

FORM #280 – REQUEST FOR CLOSED HEARING ON PETITION FOR STEP-PARENT ADOPTION; AND ORDER SETTING HEARING 4th Judicial District Forms – Pro Se Parenting (05/16) Page 1 of 2

_____________________________________ Name _____________________________________ Address _____________________________________ City State Zip Code _____________________________________ Phone Number _____________________________________ Email Address



_________________________, Minor Child.

_________________________, Petitioner.

Dept. No. : ____ Cause No.: DA-____________

REQUEST FOR CLOSED HEARING ON PETITION FOR STEP-PARENT ADOPTION

AND ORDER SETTING HEARING

The Petitioner, _________________________, respectfully requests

a hearing on the Petition for Step-Parent Adoption. Petitioner is the step-

parent of the child. Both Petitioner’s spouse/__________ and the

relinquishing parent have consented to the adoption, and their Consent has

been filed with the Court; or diligent efforts have been made to provide

notice of these proceedings to him/her. Petitioner requests that the hearing

in the above-titled matter be CLOSED. Dated this _______day of

_________________, 20____. _____________________(Petitioner)

FORM # 280

FORM #280 – REQUEST FOR CLOSED HEARING ON PETITION FOR STEP-PARENT ADOPTION; AND ORDER SETTING HEARING 4th Judicial District Forms – Pro Se Parenting (05/16) Page 2 of 2

Judge ________________ Missoula District Court 200 W. Broadway Missoula, MT 59802



_________________________, Minor Child.

_________________________, Petitioner.

Dept. No. : _____ Cause No.: DA-___________

ORDER SETTING CLOSED HEARING

The Court hereby waives any pre-placement evaluation and six-

month post-placement evaluation and report and sets the Petition for Step-

Parent Adoption for a CLOSED HEARING as follows:

Hearing is set for the _________ day of ___________, 20____ at

_________o’clock ___.m. by order of the Court.

DATED this _________day of ________, 20____.

_________________________________ District Court Judge

FORM #281 – STEP-PARENT ADOPTION DECREE Page 1 of 6 4th Judicial District Forms - Pro se Parenting (Revision Date: 5/16)

_____________________________________ Name _____________________________________ Address _____________________________________ City State Zip Code _____________________________________ Phone Number _____________________________________ Email Address MONTANA FOURTH JUDICIAL DISTRICT COURT MISSOULA COUNTY

IN RE THE ADOPTION OF: ___________________________, Minor child. ___________________________, Petitioner.

Dept. No. : _____ Cause No.: DA-_____________

ADOPTION DECREE

A Petition for Step-parent Adoption was filed in this case on _________________, _______. A hearing was held on: (mm/dd/yyyy) ________________________. Based on the evidence, the Court hereby (mm/dd/yyyy) issues the following:

FINDINGS OF FACT

1. Petitioner The Petitioner’s name is _____________________________.

FORM # 281


The Petitioner’s relationship to the child’s custodial parent is: __________________. (husband, wife, etc.) The child’s custodial parent’s name is: ___________________, who is the ___ Mother ____Father of the minor child.

If the Petitioner is the spouse of the custodial parent, he or she had legal and physical custody of the child and the child had been in the physical custody of the Petitioner and the custodial parent during the 60 days preceding the filing of a petition for adoption; or Good cause is shown that Petitioner, who is not a stepparent, has the consent of the custodial parent of the child to file a petition for adoption. 2. Minor Child The child’s name is _____________________________________. Child’s Full Name The child was born in ____________________________________. City State on (mm/dd/yyyy): _________________________________. 3. Physical and Legal Custody of the Child The child lives with: ______________________________________. (Name of Biological Parent Child Lives With) This parent has legal and physical custody of the child. The child has

lived with this parent since (mm/dd/yyyy): __________________.

Check if Applicable: A parenting plan or custody agreement regarding this child was

entered on (mm/dd/yyyy) _________________ by the (Name of Court)

_______________in (County) _____________________, (State)

__________________.


4. Child’s Relationship to Petitioner

or

The Petitioner is married to the child’s natural Mother /

Father. The child has lived with and been in the Petitioner’s physical

custody since (mm/dd/yyyy): _____________.

Describe Petitioner’s relationship to child and custodial parent:

5. Parents’ ConsentBoth of the child’s natural parents filed written consents to this step-

parent adoption. The non-custodial parent has waived notice of the

hearing, relinquished parental rights to the child, and consented to this

step-parent adoption, or diligent efforts have been made to provide

notice to him/her of these proceedings.

6. Parent Child RelationshipThe Petitioner wants to adopt the child and form a parent/child

relationship. The Petitioner also wants all the rights and duties that

go along with a parent/child relationship.

7. Child’s NameThe Petitioner would like to:

Change the child’s name to: _________________________. (Child’s New Name)

______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________


Keep the child’s name the same.

8. Child’s PropertyThe child does not own any property of value.

9. EvaluationsThe Petitioner asks the court to waive the pre and post-placement

evaluations.

10. NoticeBoth parents have consented to this adoption or diligent efforts have

been made to provide notice to him/her of these proceedings. No

other party is entitled to receive notice of this Petition.

Based on the foregoing Findings of Fact, the Court hereby makes the

following:

CONCLUSIONS OF LAW

1. This court has jurisdiction over this adoption.

2. The Petitioner and child both live in this county. This court is the

proper venue for this step-parent adoption.

3. It is in the child’s best interests to terminate the rights of the

biological:

Mother.

Father.

The adoption by the step-parent is in the child’s best interests and


should be ordered. Montana Code Annotated §42-5-109(4).

4. It is in the child’s best interest for the natural:

Mother

Father

to keep all rights as the child’s natural parent. Montana Code

Annotated §42-5-202(b).

5. Because the Petitioner is the child’s step-parent or ________, it is in

the child’s best interests for the court to waive the placement

evaluation. Montana Code Annotated §42-5-107.

ORDER This Court HEREBY orders that:

1. The parent/child relationship is terminated between the child and the

biological:

Mother.

Father.

This parent no longer has any rights to the child unless there is a

court order for visits or communication with someone related to the

child through one of the parents.

2. The child keeps the right to inherit from the parent who pre-deceased

this adoption.

3. The former parent will still owe any past due child support unless it is


waived by the other parent and Child Support Enforcement Division.

4. This final decree of adoption creates a parent/child relationship

between the Petitioner and the child. All the rights and duties of a

parent/child relationship now exist between the Petitioner and the

child.

3. The parent/child relationship that existed before this step-parent

adoption between the child and the natural:

Mother

Father

will remain unchanged.

4. The post-placement evaluation for this adoption are waived.

5. The child was born:

in Montana

in another state.

If the child was born in Montana and is under age 12, the Department

of Vital Statistics shall issue a new birth certificate for the child.

7. The child’s name:

is changed to: _________________________________. Child’s New Name

will stay the same.

Dated this ____ day of ___________________20__.

________________________________________ DISTRICT COURT JUDGE

FORM # 282 – NOTICE TO CSED TO TERMINATE CHILD SUPPORT OBLIGATION 4th Judicial District Forms – Pro Se (05/16) Page 1 of 2

Fourth Judicial District Missoula County Courthouse 200 West Broadway Missoula, Montana 59802 (406) 258-4780Fax (406) 258 - 4899


IN RE THE ADOPTION OF: _________________________,

Minor Child.

__________________________, Petitioner.

Dept. No.: _____ Cause No.: DA-_________

ORDER

On __________________ (date) the Court ordered the

Adoption of ______________________ (a minor child) by Petitioner.

Therefore, the Court hereby Orders that the child support obligation

of the relinquishing parent: (_____________________________) is

hereby terminated as of the date of the Adoption.

Any child support obligation accruing prior to the date of the Adoption

is not affected by the Adoption, and is still owing.

Petitioner is hereby ORDERED to provide a certified copy of this

FORM #282

FORM # 282 – NOTICE TO CSED TO TERMINATE CHILD SUPPORT OBLIGATION 4th Judicial District Forms – Pro Se (05/16) Page 2 of 2

Order to the relinquishing parent if address is known, and a certified

copy to Child Support Enforcement Division (CSED) of the State of

Montana if there is an existing child support Order which CSED is

enforcing or if CSED has an open case.

So ORDERED this ____ day of __________________, 20____.

___________________________ District Court Judge

FORM #25 - VITAL STATISTICS REPORTING FORM Page 1 4th Judicial District Forms - Pro se Dissolution (Revision Date: 02/12)

INSTRUCTIONS

Order Information: Check the box that most accurately describes the type of order being entered. If it is dissolution of marriage, enter the place of marriage and indicate if child support is ordered. Temporary support orders and paternity orders that contain child support are categorized as “child support order, without dissolution.” “Child support order” includes medical support orders. If the order does not contain a child support order, social security numbers of the parties are not required and only Parts 1, 2 and 9 need to be completed.

Parts 1 and 2: Provide information about the parties to the order. If there is a child support order, be sure to check the box that shows whether the party owes support (payer) or will receive support (payee). If a party is ordered to both pay and receive support, check the box labeled “both.” If there is no support order, check the box labeled “N/A” for not applicable. If a party is ordered to pay $0 support, that party should be considered a payer.

Part 3: Provide information about the children named in the order and indicate which parent or other party the children live with. If the parenting plan provides for shared residential parenting, circle “B” for both. If a child is not living with either parent, circle “O” and list the child’s name and address.

Part 4: Complete this part if support is ordered to be paid to an agency or an individual other than a parent.

Part 5: Indicate whether any of the parties are protected from each other by a protective or restraining order. If yes, list the names of the protected parties. This includes any protected children.

Part 6: Provide information about the employment or other source of income of the party who is ordered to pay child support. If both parties are ordered to pay support, skip Part 6 and complete Part 10 instead.

Part 7: Provide information about the support order. Check the type(s) of support ordered and enter the amount and how often it is due. (Example: $100 per week.) All orders should have a “begin” date; many will not have an “end” date. If both parties are ordered to pay support, skip Part 7 and complete Part 11 instead.

If the order enters a judgment for past due support, show the total amount of the judgment. If the judgment includes amounts for penalties, fees or interest, list those amounts on the appropriate lines. List any special conditions of the support order. (Example: support is due until the child graduates from college.) Copy the information requested about the guidelines to this form from the guidelines worksheet.

Part 8: Provide information about health insurance coverage for the children. If insurance is not provided, indicate whether it is available through the employer of either parent. Relationship of the party providing insurance is the party’s relationship to the children. (Example: mother, father, mother’s spouse, father’s spouse.) List the terms and conditions of the insurance coverage. (Example: 80/20 plan, $500 deductible, major medical only.)

Part 9: Provide information about the person completing this form.

Part 10: Employment information for multiple payers. Complete only if both parties are ordered to pay support. See Part 6 instructions.

Part 11: Order information for multiple payers. Complete only if both parties are ordered to pay support. See Part 7 instructions.

FORM # 283

MONTANA STATE CASE REGISTRY AND VITAL STATISTICS REPORTING FORM DEPARTMENT OF PUBLIC HEALTH AND HUMAN SERVICES (revised 12/15) Page 2 of 5

MONTANA STATE CASE REGISTRY AND VITAL STATISTICS REPORTING FOR

DEPARTMENT OF PUBLIC HEALTH AND HUMAN SERVICES

County / Tribe __________________________________ Judicial District No._______ Cause No. _______________

Date Decree/ Order Signed _____________________________

☐ Dissolution of MarriageCounty that Issued Marriage License___________________ City, County, State of Marriage ________________________ Date of Marriage ___________________________________ ☐ With Child Support Order☐ Without Child Support Order (Complete Parts 1, 2 & 9

only)☐ Modification of Child Support Order

☐ Child Support Order, without Dissolution(Includes Temporary Support Orders and Paternity Orders with Child Support)

☐ Legal Separation with Child Support Order☐ Dependent Neglect / Juvenile Delinquency☐ Invalid Marriage - Specify Legal Grounds forAction

1 Mother/Wife: ☐ Payer ☐ Payee ☐ Both ☐ N/A Maiden Name: ____________________________

Name:_____________________________________________ SSN:_______________ Telephone:______________ Last First Middle/Suffix

Mailing Address:________________________________________________________________________________ Street City State Zip

Residential Address (if different from above): _________________________________________________________ Date of Birth: ___________________________ Place of Birth: _____________________________ Race: _______

State / Foreign CountryDriver’s License # / State _____________________________ Occupation: _________________________________ Number of this marriage (1st, 2nd, etc.):_____ Date, City & State of previous marriage(s): ____________________

2 Father/Husband: ☐ Payer ☐ Payee ☐ Both ☐ N/A

Name:_____________________________________________ SSN:_______________ Telephone:______________ Last First Middle/Suffix

Mailing Address:_________________________________________________________________________________ Street City State Zip

Residential Address (if different from above): __________________________________________________________ Date of Birth: ___________________________ Place of Birth:____________________________ Race:_______

State / Foreign CountryDriver’s License # / State _____________________________ Occupation:_________________________________ Number of this marriage (1st, 2nd, etc.):_____ Date, City & State of previous marriage(s): _____________________

______________________________________________________________________________________________________________________________

________________________________________________________________________________


☐ Other Payee: If support is to be paid to another payee, check here and complete Part 4.

3 Names of Children Included in the Support Order Residing Last First Middle Date of Birth Sex SSN With ** _________________________________________ _________________ M F ___________________ M F B O _________________________________________ _________________ M F ___________________ M F B O _________________________________________ _________________ M F ___________________ M F B O _________________________________________ _________________ M F ___________________ M F B O _________________________________________ _________________ M F ___________________ M F B O _________________________________________ _________________ M F ___________________ M F B O

* M = Mother F = Father B = Both O = Other

If any of the above-named children are not residing with a parent, list the child’s name and address : ________________________________________________________________________________________________________ ________________________________________________________________________________________________________

4 Other Payee: Name of person/agency owed support if not parent:______________________________________________________

Last Name or Agency Name First Middle

Mailing Address:_________________________________________________________Telephone: ______________ Street City State Zip

Residential Address (if different from above): _________________________________________________________

5 Protective Order: Is a party to this action protected from another party to the action by an order of protection? ☐ Yes ☐ NoIf yes, enter name(s) of protected____________________________________________________________________party(ies):____________________________________________________________

6 Employer/Income Source Information: Provide information about the payer’s employment or periodic source of income. (Attach additional pages if needed.) ☐ Check here if this order requires both parties to pay support and skip Parts 6 & 7 and complete Parts 8, 9, 10 &

11. ______________________________________________________________________________________________Name of Employer or Source of Income Telephone

_______________________________________________________________________________________________Street City State Zip

7 Support Order: Date Order Signed:_________________

Check type of support and enter appropriate information If applicable, arrears due at time of order: $ ____________

Support Type Total Due Frequency Begin Date End Date Judgment Penalty* Fees* Interest*

☐ Child Support: $__________ per __________ ________ ________ $_______ $______ $_______ $______


☐ Medical Support: $__________ per __________ ________ ________ $_______ $______ $_______ $______

☐ Spousal Support: $__________ per __________ ________ ________ $_______ $______ $_______ $______(Alimony)

Is payer exempt from income withholding under MCA §40-5-315? ☐ No ☐ Yes ☐ Tribal Order List any special terms/conditions of the support order(s): _________________________________________________ _______________________________________________________________________________________________ Was the mother represented by an attorney? ☐ Yes ☐ No Was the father represented by an attorney? ☐ Yes ☐ No

Information from child support guidelines worksheet: Mother “Income after Deductions”: $_________ “Credit for Payment of Expenses”: $_____

Father “Income after Deductions”: $_________ “Credit for Payment of Expenses”: $_____

8 Health Insurance: (Attach additional pages if needed.) Is health insurance provided for the children? ☐ Yes ☐ No (If no, answer last question in this section) Name and relationship of party providing insurance: ________________________________ Policy No. ___________ Name of insurance carrier or health benefit plan :________________________________________________________ Address of insurance carrier or health benefit plan: _____________________________________________________ Names of children covered: _______________________________________________________________________ Terms/conditions of coverage: ______________________________________________________________________ If children are not covered, is coverage available through:

Father’s employer? ☐ Yes ☐ No Mother’s employer? ☐ Yes ☐ No

9 This form was completed by: Name / Title: _________________________________________________________ Telephone: ________________ Signature: __________________________________ Date: __________________

Complete next page if both parties are ordered to pay child support. Information contained in this form is private and confidential. It may only be shared with courts, agencies and individuals authorized by MCA 40-5-923.

Multiple Payers: Complete Parts 10 and 11 only if the order requires both parties to pay support.

10 Mother’s Employer/Income Source Information: Provide information about the mother’s employment or periodic source of income. (Attach additional pages if needed.) _______________________________________________________________________________________________ Name of Employer or Source of Income Telephone

_______________________________________________________________________________________________ Street City State

Zip

Father’s Employer/Income Source Information: Provide information about the father’s employment or periodic source of income. (Attach additional pages if needed.) ______________________________________________________________________________________________Name of Employer or Source of Income Telephone

_______________________________________________________________________________________________ Street City State

Zip


11 Support Order: Date Order Signed:_________________

Mother’s Support Obligation If applicable, arrears due at time of order: $ _____

Check type of support and enter appropriate information

Support Type Total Due Frequency Begin Date End Date Judgment Penalty * Fees* Interest* (*list amounts if included in judgment)




Is the mother exempt from income withholding under MCA §40-5-315? ☐ No ☐ Yes ☐ Tribal Order

Father’s Support Obligation If applicable, arrears due at time of order: $ ________

Check type of support and enter appropriate information Support Type Total Due Frequency Begin Date End Date Judgment Penalty* Fees* Interest*

(*list amounts if included in judgment)




Is the father exempt from income withholding under MCA §40-5-315? ☐ No ☐ Yes ☐ Tribal Order

List any special terms/conditions of the support order(s): _________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________

Was the mother represented by an attorney? ☐ Yes ☐ No Was the father represented by an attorney? ☐ Yes ☐ No

Information from child support guidelines worksheet: Mother: “Income after Deductions”: $_________ “Credit for Payment of Expenses”: $_________ Father: “Income after Deductions”: $_________ “Credit for Payment of Expenses”: $_________

__________________

Documents

PACKET “Q” Step-Parent Adoption