[30 Pa.B. 6549]
[Continued from previous Web Page]
TABLE OF APPENDICES Note: The Table of Appendices and forms have not been reproduced in this publication.
ORPHANS COURT DIVISION RULE 15 Rule 15. Adoption.
Sec. 1. Venue.
A proceeding for voluntary relinquishment, involuntary termination of parental rights, confirm consent to adoption, or adoption may be brought in the County of Allegheny if the parent or parents or the adoptee or person or persons who have filed a report of intent to adopt, reside in Allegheny County, or if an office of an agency having custody of or having placed the adoptee is located therein. Such a proceeding may also be brought with leave of Court in Allegheny County if the adoptee formerly resides in Allegheny County.
Sec. 2. Parties.
Any individual may be adopted, regardless of his age or residence. Any individual may become an adopting parent. Parent includes adoptive parent.
Sec. 3. Voluntary Relinquishment. Relinquishment to Agency. Petition.
(a) A petition of a parent or parents for permission to relinquish forever all parental rights and duties with respect to a child under the age of eighteen years who has been in the care of an agency for a minimum period of three (3) days, or, whether or not the agency has the physical care of the child, the agency has received a written notice of the present intent to transfer to it custody of the child, executed by the parent, shall contain the following information:
(1) The name and address of petitioner and identity, i.e., parent.
(2) The name, address, age, racial background and religious affiliation of the parent or parents, and all alleged parents and any deceased parent.
(3) The marital status of the mother as of the time of birth of the child and during one (1) year prior thereto, and, if the mother has ever been married, the name of her husband or husbands, and her maiden name and how prior marriages were terminated;
(4) The name, age, date of birth, racial background, sex and religious affiliation of the child; the name of the child shall include all names by which child has been identified on the birth certificate and any other legal document;
(5) The name and address of the agency having care of the child;
(6) The date when the child was placed with the agency;
(7) When the child is born out of wedlock, whether the mother and father of the child intend to marry;
(8) If the mother of the child was married within one (1) year prior to the birth of the child but identifies the natural father as a person other than her spouse, then the information as to the spouse (legal father) of the mother shall be set forth as required in subparagraph (2);
(9) The date on which the parent has executed a written notice of the present intent to transfer to the agency custody of the child, if said notice was executed;
(10) The reasons for seeking relinquishment.
(11) If Petitioner also seeks to terminate the parental rights of the putative father, then state whether or not the putative father has filed a petition to Voluntarily Relinquish his parental rights pursuant to 23 Pa.C.S.A. Section 2501 and 2503 and whether the putative father has filed an Acknowledgment of Paternity or Claim of Paternity pursuant to 23 Pa.C.S.A. Section 8302 or 8303.
The prayer shall be for permission to relinquish forever all parental rights and duties of the Petitioner with respect to the child and to award to the agency the custody of the child. The prayer may also be for permission to terminate the parental rights of the putative father pursuant to 23 Pa.C.S.A. Section 2503(d).
(b) Exhibits.
The petition shall have attached to it the following exhibits:
(1) An original or certified birth certificate or certification of registration of birth of the child;
(2) The written notice executed by the Petitioner to the agency of that parent's present intent to transfer to the agency custody of the child, if applicable;
(3) The joinder of the agency having care of the child and the consent to the agency to accept custody of the child until such time as the child is adopted.
(4) Original or certified copy of any previous divorce decrees relating to the mother and original or certified copy of mother's previous election to resume maiden name, if applicable;
(5) Original or certified copy of documentation from appropriate State Agency certifying Acknowledgement of Paternity or Claim of Paternity indicating that no acknowledgement of paternity or claim of paternity has been filed.
(c) Preliminary Decree and Hearing.
Upon presentation of the petition, the Court, by preliminary decree, shall fix a time for hearing which shall be not less than ten days after filing of the petition. Notice shall be given to the Petitioner. Notice of the hearing shall also be given to the other parent including any alleged natural father, to the putative father whose parental rights could be terminated pursuant to 23 Pa.C.S.A. Section 2503(d), and to the legal father (spouse of mother within during one (1) year prior to birth, if he is not identified as the natural father, and to the parents or guardians of a Petitioner who has not reached the age of 18 years. The Petitioner and an authorized representative of the agency (if agency is involved) shall be examined under oath at the hearing. The hearing shall be in private. The notices shall be in substantially the following forms, and Affidavit/Proof of Service of the required notices of hearing shall be filed with the Court at least five (5) days prior to the scheduled hearing.
(1) Notice to Petitioner of Hearing on Petition for Voluntary Relinquishment.
(Caption of Case) TO: (name of petitioner) , MOTHER/FATHER/LEGAL FATHER OF (adoptee's name) , BORN ON THE ____ DAY OF ______ , ____ , AT (hospital) , (city) , (county) , (state) .
A PETITION HAS BEEN FILED ASKING THE COURT TO PUT AN END TO ALL RIGHTS YOU HAVE TO YOUR CHILD, (insert name of child). THE COURT HAS SET A HEARING TO CONSIDER ENDING YOUR RIGHTS TO YOUR CHILD. THAT HEARING WILL BE HELD IN ORPHANS' COURT, 1700 FRICK BUILDING, 437 GRANT STREET, PITTSBURGH, PENNSYLVANIA ON ____ , AT ____ __ .M. YOUR PRESENCE IS REQUIRED AT THE HEARING. YOU HAVE A RIGHT TO BE REPRESENTED AT THE HEARING BY A LAWYER. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP.
LAWYER REFERRAL SERVICE
The Allegheny County Bar Association
920 City-County Building
Pittsburgh PA 15219
(412) 261-2088__________Name of Attorney
Address
Telephone Number(2) Notice to the Other Parent and Legal Father.
(Caption of Case) TO: (other parent and/or legal father) , MOTHER/
FATHER/LEGAL FATHER OF (adoptee's name) , BORN ON THE ____ DAY OF ______ , ____ , AT (hospital) , (city) , (county) , (state) .A PETITION HAS BEEN FILED BY (petitioner's name) ASKING THE COURT TO PUT AN END TO ALL RIGHTS SHE/HE HAS TO YOUR CHILD, (name of adoptee). THE COURT HAS SET A HEARING TO CONSIDER ENDING HIS/HER RIGHTS TO YOUR CHILD. THAT HEARING WILL BE HELD IN ORPHANS' COURT, 1700 FRICK BUILDING, 437 GRANT STREET, PITTSBURGH, PENNSYLVANIA ON ______ , AT ____ __ .M. A COPY OF THE NOTICE TO PETITIONER IS ATTACHED.
__________Name of Attorney
Address
Telephone Number(3) Notice to Putative Father whose rights may be terminated.
(Caption of Case) TO: (name of putative father) , FATHER OF (adoptee's name) BORN ON THE ____ DAY OF ______ , ____ , AT (hospital) , (county) , (city) , (state) .
A PETITION HAS BEEN FILED BY (petitioner's name) ASKING THE COURT TO PUT AN END TO ALL RIGHTS SHE HAS TO YOUR CHILD, (name of adoptee). THE COURT HAS SET A HEARING TO CONSIDER ENDING HIS/HER RIGHTS TO YOUR CHILD. THAT HEARING WILL BE HELD IN ORPHANS' COURT, 1700 FRICK BUILDING, 437 GRANT STREET, PITTSBURGH, PENNSYLVANIA ON ______ , AT ____ __ .M. A COPY OF THE NOTICE TO PETITIONER IS ATTACHED.
YOUR RIGHTS TO (adoptee's name) MAY ALSO BE TERMINATED IF YOU FAIL TO FILE EITHER AN ACKNOWLEDGEMENT OF PATERNITY OR CLAIM OF PATERNITY PURSUANT TO 23 Pa.C.S.A. SECTION 5103 AND YOU FAIL TO EITHER APPEAR AT THIS HEARING FOR THE PURPOSE OF OBJECTING TO THE TERMINATION OF YOUR RIGHTS TO (adoptee's name) OR YOU FAIL TO FILE A WRITTEN OBJECTION TO THE TERMINATION OF YOUR RIGHTS WITH THE COURT PRIOR TO THIS HEARING.
YOU HAVE A RIGHT TO BE REPRESENTED AT THE HEARING BY A LAWYER. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP.
LAWYER REFERRAL SERVICE
The Allegheny County Bar Association
920 City-County Building
Pittsburgh PA 15219
(412) 261-2088__________Name of Attorney
Address
Telephone Number(4) Notice to Parent(s) or Guardian of Petitioner who has not reached the age of 18 years.
(Caption of Case) TO: ____ , MOTHER/FATHER OF ______ , MINOR NATURAL FATHER/MOTHER OF (adoptee's name) BORN ON THE ____ DAY OF ______ , ____ , AT (hospital) , (county) , (city) , (state) .
A PETITION HAS BEEN FILED ASKING THE COURT TO PUT AN END TO ALL RIGHTS (name of minor natural parent) HAS TO HIS/HER CHILD, (adoptee's name) . THE COURT HAS SET A
HEARING TO CONSIDER ENDING HIS/HER RIGHTS TO HIS/HER CHILD. THAT HEARING WILL BE HELD IN ORPHANS' COURT, 1700 FRICK BUILDING, 437 GRANT STREET, PITTSBURGH, PENNSYLVANIA ON ______ , AT ____ __ .M. A COPY OF THE NOTICE TO PETITIONER IS ATTACHED.__________Name of Attorney
Address
Telephone Number(d) Final Decree. (1) A decree of termination in substantially the following form shall be submitted to the Court at the hearing:
And now, this ____ day of ______ , ____ , the foregoing Petition For Voluntary Relinquishment of Parental Rights and duties to an Agency having been heard, upon consideration thereof and of the supporting testimony and it appearing that ______ desires to relinquish forever all parental rights with respect to ______ , the Court finds the averments of facts in said petition are true and that the prayer of the petition should be granted;
Now, therefore it is ordered, adjudged and decreed that all parental rights and duties of ______ with respect to said child are hereby terminated in accordance with The Adoption Act, 23 Pa.C.S.A. Section 2501 and 2503; said termination to extinguish the power or right of said ______ to object to or receive notice of adoption proceedings; and that custody of ______ is hereby awarded to ______ .
______ , J
(2) If the rights of the putative father will also be terminated pursuant to 23 Pa.C.S.A. Section 2503(d) then a decree in substantially the following form shall be submitted to the Court at the hearing:
And now, this ____ day of ______ , ____ , the foregoing Petition For Voluntary Relinquishment of Parental Rights and duties to an Agency having been heard, upon consideration thereof and of the supporting testimony and it appearing that ______ desires to relinquish forever all parental rights with respect to ______ , the Court finds the averments of facts in said petition are true and that the prayer of the petition should be granted;
Now, therefore it is ordered, adjudged and decreed that all parental rights and duties of ______ with respect to said child are hereby terminated in accordance with The Adoption Act, 23 Pa.C.S.A. Section 2501 and 2503; said termination to extinguish the power or right of said ______ to object to or receive notice of adoption proceedings;
Furthermore, the Court finds that the putative father, ______ will not file a Petition to voluntarily relinquish his parental rights pursuant to The Adoption Act, 23 Pa.C.S.A. Section 2501 and 2503, he has not filed an Acknowledgement of Paternity or Claim of Paternity pursuant to 23 Pa.C.S.A. Section 5103, he has not appeared to object to the termination of his parental rights to said child, and has not filed a written objection with this Court to the termination of his parental rights to said child;
Now, therefore it is ordered, adjudged and decreed that the parental rights of the putative father______ with respect to said child are hereby terminated in accordance with 23 Pa.C.S.A. Section 2503 (d); said termination to extinguish the power or right of said ______ to object to or receive notice of adoption proceedings;
It is further ordered and decreed that custody of ______ is hereby awarded to ______ .
______ , J
(e) Right to file personal information. At the time the decree of termination is transmitted to the parents whose rights are terminated, the Court shall advise that parent in writing of his or her right to place personal information on file with the Court and with the Department of Health pursuant to 23 Pa.C.S.A. Section 2905 (d) (relating to impounding of proceedings and access to records).
Sec. 4. Relinquishment to Adult Intending to Adopt Child. Petition.
(a) A petition of a parent for permission to relinquish forever all parental rights with respect to a child under the age of eighteen years who has been in the exclusive care of an adult or adults for minimum period of thirty days, and who have filed a Report of Intention to Adopt as required by the Adoption Act, 23 Pa.C.S.A. Section 2531 shall contain the following information:
(1) The name and address of the Petitioner and identity, i.e., parent;
(2) The name, address, age, racial background, and religious affiliation of the parent or parents; and all alleged parents and any deceased parent;
(3) The marital status of the mother as of the time of the birth of the child and during one (1) year prior thereto, and if the mother has ever been married, the name of her husband or husband's and/or maiden name and how prior marriages were terminated;
(4) The name, age, date of birth, racial background, sex and religious affiliation of child; the name of the child shall include all names by which child has been identified on the birth certificate and any other legal document;
(5) The date when the Report of Intention to Adopt was filed;
(6) The date when the child was placed with the adult or adults intending to adopt;
(7) When the child is born out of wedlock, whether the mother and father of the child intend to marry;
(8) If the child is born out of wedlock and the father has been identified, information as to the father shall be set forth as required in subparagraph (2);
(9) If the mother of the child was married within one (1) year prior to the birth of the child but identified the natural father as a person other than this spouse, then the information as to the spouse (legal father) of the mother shall be set forth as required in subparagraph (2);
(10) If the natural father is unknown, whether there has been any claim of paternity pursuant to 23 Pa.C.S.A. Section 5103.
(11) The reasons for seeking relinquishment.
(12) If Petitioner also seeks to terminate the parental rights of the putative father, then state whether or not the putative father has filed a Petition to Voluntarily Relinquish his parental rights pursuant to 23 Pa.C.S.A. Section 2502 and 2503 and whether the putative father has filed an Acknowledgement of Paternity or Claim of Paternity pursuant to 23 Pa.C.S.A. Section 5103.
The prayer shall be for permission to relinquish forever all parental rights to the child and to award to the adult or adults intending to adopt, custody of the child. The prayer may also be for permission to terminate the parental rights of the putative father of the child pursuant to the 23 Pa.C.S.A. Section 2503 (d).
(b) Exhibits. The petition shall have attached to it the following exhibits:
(1) An original or certified birth certificate or certification of registration of birth of the child;
(2) The separate consent of the adult or adults intending to adopt, to accept custody of the child;
(3) Original or certified copy of any previous divorce decrees relating to the mother and original or certified copy of any previous elections to resume maiden name relating to the mother;
(4) Original or certified copy of Acknowledgement of Paternity or Claim of Paternity indicating that no acknowledgement of paternity or claim of paternity has been filed.
(c) Preliminary Decree and Hearing. Upon presentation of the petition the Court, by preliminary decree, shall fix a time for hearing which shall be not less than ten (10) days after filing of the petition. Notice of the hearing shall be given to the Petitioner. Notice of the hearing shall also be given to the other parent, to the putative father whose parental rights could be terminated pursuant to 23 Pa.C.S.A. Section 2503 (d), to the legal father (spouse of mother within one year prior to birth), if he is not identified as the natural father, and to the parents or guardians of a Petitioner who has reached the age of 18. The Petitioner and an authorized representative from the agency (if agency is involved), shall be examined under oath at the hearing. The hearing shall be in private. The notices shall be in substantially the following forms and Affidavit/Proof of Service of the required notices of hearing shall be filed with the Court at least five (5) days prior to the scheduled hearing.
(1) Notice to Petitioner of Hearing on Petition for Voluntary Relinquishment.
(Caption of Case) TO: (name of Petitioner) , MOTHER/FATHER/
LEGAL FATHER OF (adoptee's name) , BORN ON THE ____ DAY OF ______ , ____ , AT (hospital) , (city) , (county) , (state) .A PETITION HAS BEEN FILED ASKING THE COURT TO PUT AN END TO ALL RIGHTS YOU HAVE TO YOUR CHILD, (insert name of child). THE COURT HAS SET A HEARING TO CONSIDER ENDING YOUR RIGHTS TO YOUR CHILD. THAT HEARING WILL BE HELD IN ORPHANS' COURT, 1700 FRICK BUILDING, 437 GRANT STREET, PITTSBURGH, PENNSYLVANIA ON ______ , AT ____ __ .M. YOUR PRESENCE IS REQUIRED AT THE HEARING. YOU HAVE A RIGHT TO BE REPRESENTED AT THE HEARING BY A LAWYER. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP.
LAWYER REFERRAL SERVICE
The Allegheny County Bar Association
920 City-County Building
Pittsburgh PA 15219
(412) 261-2088__________Name of Attorney
Address
Telephone Number(2) Notice to the Other Parent and Legal Father.
(Caption of Case) TO: (other parent and legal father) , MOTHER/
FATHER/LEGAL FATHER OF (adoptee's name) , BORN ON THE ____ DAY OF ______ , ____ , AT (hospital) , (city) , (county) , (state) .A PETITION HAS BEEN FILED BY (Petitioner's name) ASKING THE COURT TO PUT AN END TO ALL RIGHTS SHE HAS TO YOUR CHILD, (name of adoptee). THE COURT HAS SET A HEARING TO CONSIDER ENDING HIS/HER RIGHTS TO YOUR CHILD. THAT HEARING WILL BE HELD IN ORPHANS' COURT, 1700 FRICK BUILDING, 437 GRANT STREET, PITTSBURGH, PENNSYLVANIA ON ______ , AT ____ __ .M. A COPY OF THE NOTICE TO PETITIONER IS ATTACHED.
__________Name of Attorney
Address
Telephone Number(3) Notice to Putative Father whose rights may be terminated.
(Caption of Case) TO: (putative father) , FATHER OF (adoptee's name) , BORN ON THE ____ DAY OF ______ , ____ , AT (hospital) , (city) , (county) , (state) .
A PETITION HAS BEEN FILED BY (Petitioner's name) ASKING THE COURT TO PUT AN END TO ALL RIGHTS SHE HAS TO YOUR CHILD, (name of adoptee). THE COURT HAS SET A HEARING TO CONSIDER ENDING HIS/HER RIGHTS TO YOUR CHILD. THAT HEARING WILL BE HELD IN ORPHANS' COURT, 1700 FRICK BUILDING, 437 GRANT STREET, PITTSBURGH, PENNSYLVANIA ON ______ , at ____ __ .M. A COPY OF THE NOTICE TO PETITIONER IS ATTACHED.
YOUR RIGHTS TO (adoptee's name) MAY ALSO BE TERMINATED IF YOU FAIL TO FILE EITHER AN ACKNOWLEDGEMENT OF PATERNITY OR CLAIM OF PATERNITY PURSUANT TO 23 Pa.C.S.A. SECTION 5103 AND YOU FAIL TO EITHER APPEAR AT THIS HEARING FOR THE PURPOSE OF OBJECTING TO THE TERMINATION OF YOUR RIGHTS TO (adoptee's name) OR YOU FAIL TO FILE A WRITTEN OBJECTION TO THE TERMINATION OF YOUR RIGHTS WITH THE COURT PRIOR TO THIS HEARING.
YOU HAVE A RIGHT TO BE REPRESENTED AT THE HEARING BY A LAWYER. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP.
LAWYER REFERRAL SERVICE
The Allegheny County Bar Association
920 City-County Building
Pittsburgh PA 15219
(412) 261-2088__________Name of Attorney
Address
Telephone Number(4) Notice to Parent(s) or Guardian of Petitioner who has not reached the age of 18 years.
(Caption of Case) TO: ______ , MOTHER/FATHER OF_____ ______ MINOR NATURAL FATHER/MOTHER OF (adoptee's name) , BORN ON THE ____ DAY OF ______ , ____ , AT (hospital) , (county) , (city) , (state) .
A PETITION HAS BEEN FILED ASKING THE COURT TO PUT AN END TO ALL RIGHTS (name of minor natural parent) HAS TO HIS/HER CHILD (adoptee's name) . THE COURT HAS SET A HEARING TO CONSIDER ENDING HIS/HER RIGHTS TO HIS/HER CHILD. THAT HEARING WILL BE HELD IN ORPHANS' COURT, 1700 FRICK BUILDING, 437 GRANT STREET, PITTSBURGH, PENNSYLVANIA ON ______ , ____ AT ____ __ .M. A COPY OF THE NOTICE TO PETITIONER IS ATTACHED.
__________Name of Attorney
Address
Telephone Number(d) Final Decree.
(1) A decree of termination in substantially the following form shall be submitted to the Court at the Hearing:
And now, this ____ day of ______ , ____ , the foregoing Petition for Voluntary Relinquishment of Parental Rights to an adult(s) intending to Adopt Child having come on to be heard, upon consideration thereof and of the supporting testimony and it appearing that ______ , desires to relinquish forever all parental rights with respect to ______ , the Court finds the averments of facts in said petition are true and that the prayer of the petition should be granted;
Now, therefore, it is ordered, adjudged and decreed that the parental rights of the ______ , ______ with respect to said child are hereby terminated in accordance with 23 Pa.C.S.A. Section 2502 and 2503; said termination to extinguish the power or right of said ______ to object to or receive notice of adoption proceedings; and that custody of ______ is hereby awarded to ______ .
______ , J
(2) If the rights of the putative father will also be terminated pursuant to 23 Pa.C.S.A. Section 2503 (d), then a decree in substantially the following form shall be submitted to the Court at the hearing:
And now, this ____ day of ______ , ____ , the foregoing Petition for Voluntary Relinquishment of Parental Rights to an Adult(s) intending to Adopt Child having come on to be heard, upon consideration thereof and of the supporting testimony and it appearing that ______ , desires to relinquish forever all parental rights with respect to ______ , the Court finds the averments of facts in said petition are true and that the prayer of the petition should be granted;
Now, therefore, it is ordered, adjudged and decreed that the parental rights of ______ with respect to said child are hereby terminated in accordance with 23 Pa.C.S.A. Section 2502 and 2503; said termination to extinguish the power or right of said ______ to object to or receive notice of adoption proceedings;
Furthermore, the Court finds that the putative father ______ will not file a Petition to voluntarily relinquish his parental rights pursuant to 23 Pa.C.S.A. Section 2502 or 2503 of the Adoption Act, he has not filed an Acknowledgement of Paternity or Claim of Paternity pursuant to 23 Pa.C.S.A. Section 5103, he has not appeared to object to the termination of his parental right to said child, and has not filed a written objection with this Court to the termination of his parental rights to said child;
Now, therefore, it is ordered, adjudged and decreed that the parental rights of the putative father ______ with respect to said child are hereby terminated in accordance with 23 Pa.C.S.A. Section 2503 (d); said termination to extinguish the power or right of said ______ to object to or receive notice of adoption proceedings;
It is further ordered and decreed that custody of ______ is awarded to ______ .
______ , J
Sec. 5. Alternative Procedure for Relinquishment. Petition to Confirm Consent to Adoption.
(a) A petition of an intermediary (or adoptive parents where there is no intermediary) to confirm the consents to an adoption where the parent has executed a consent to adoption as required by 23 Pa.C.S.A. Section 2711 and has failed for period of forty (40) days after executing the consent to file or proceed with a petition for voluntary relinquishment of parental rights, shall contain the following information:
(1) The name and address of the Petitioner and identity, i.e., parent, agency, intermediary;
(2) The name, address, age, racial background and religious affiliation of the parents, including the mother and father and all alleged parents and deceased parent;
(3) The marital status of the mother as of the time of birth of the child and during one (1) year prior thereto, and, if the mother has ever been married, the name of her husband or husbands, and her maiden name and how prior marriages were terminated;
(4) The name, age, date of birth, racial background, sex and religious affiliation of the child; the names of the child shall include all names by which the child has been identified on the birth certificate and any other legal document;
(5) The name and address of the agency, or the adopting parent(s) if non-agency adoption, having care of the child;
(6) The date when the child was placed with agency, or adopting parents if non-agency adoption;
(7) When the child is born out of wedlock, whether the mother and father of the child intend to marry;
(8) If the mother of the child was married during one (1) year prior to the birth of the child but has identified the father as a person other than her spouse, then the information as to the spouse (legal father) of the mother shall be set forth as required in subparagraph (2);
(9) If the father is unknown, whether there have been any claims of paternity or acknowledgment of paternity filed pursuant to 23 Pa.C.S.A. Section 5103;
(10) That the parent has executed a Consent to Adoption pursuant to 23 Pa.C.S.A. Section 2711 and has failed for a period forty (40) days after executing said consent to file or proceed with a petition for voluntary relinquishment of parental rights.
(11) If a putative father's rights are being terminated, pursuant to 23 Pa.C.S.A. 2504(c), that said putative father will not execute a consent to adoption as required by Section 2711 and has not filed an acknowledgement of paternity or claim of paternity pursuant to 23 Pa.C.S.A. Section 5103;
(12) That the agency, or the adopting parent(s) if a non-agency adoption, agree to accept custody of the child until such time as the child may be adopted;
(13) The reasons for seeking relinquishment.
The prayer shall request the Court to Confirm the consent to adoption and to terminate the parental rights of that parent to the child and to award custody to either the agency or, in the case of a non-agency adoption, to the adults intending to adopt. If the rights of the putative father are not to be terminated pursuant to 23 Pa.C.S.A. Section 2504(c), the prayer shall also request same.
(b) Exhibits. The petition shall have attached to it the following exhibits:
(1) The joinder, if obtainable, of a parent who is not a petitioner;
(2) An original or certified copy of the birth certificate or certification of registration of birth of the child;
(3) The separate consent of the agency, or of the adult or adults intending to adopt, to accept custody of the child until such time as the child may be adopted;
(4) Original or certified copy of any previous divorce decrees relating to the mother and original or certified copy of any previous elections to resume maiden name relating to the mother;
(5) If the natural father is unknown or if the rights of the putative father are to be terminated pursuant to 23 Pa.C.S.A. Section 2504(c), the original or certified copy of documentation from the appropriate state agency certifying that no Acknowledgment of Paternity or Claim of Paternity has been filed.
(6) The original Consent signed by the parent pursuant to 23 Pa.C.S.A. Section 2711.
(c) Preliminary Decree and Hearing. Upon presentation of the petition the Court, by preliminary decree, shall fix a time for hearing which shall be not less than ten (10) days after filing of the petition. Notice shall be given to the parent(s) whose rights are to be terminated, the other parent (including any alleged father), the putative father whose rights could be terminated pursuant to 23 Pa.C.S.A. Section 2504(c), to the legal father if he has not been identified as the father, and to the parent(s) or guardian(s) of a natural parent who has not reached the age of 18 years. Affidavit/Proof of the required notice of hearing on termination of parental rights shall be filed with Court at least five (5) days prior to the scheduled hearing.
The Petitioner unless otherwise permitted by the Court, and the witnesses to the Consent executed pursuant to Section 2711 of the Adoption Act, shall also appear unless:
(1) The signatures of the parent and witnesses are notarized; or
(2) One of the witnesses to the Consent is an attorney; or
(3) One of the witnesses to the Consent is a representative of a licensed adoption agency or child welfare agency representative.
(1) Notice to the Parent whose rights are being terminated.
(Caption of Case) TO: (name of parent) , MOTHER/FATHER/LEGAL
FATHER OF (adoptee's name) , BORN ON THE ____ DAY OF ______ , ____ , AT (hospital) , (city) , (county) , (state) .A PETITION HAS BEEN FILED ASKING THE COURT TO PUT AN END TO ALL RIGHTS YOU HAVE TO YOUR CHILD, (name of adoptee). THE COURT HAS SET A HEARING TO CONSIDER ENDING YOUR RIGHTS TO YOUR CHILD. THAT HEARING WILL BE HELD IN ORPHANS' COURT, 1700 FRICK BUILDING, 437 GRANT STREET, PITTSBURGH, PENNSYLVANIA ON ______ , AT ____ __ .M. A COPY OF THE NOTICE TO PETITIONER IS ATTACHED. YOUR ARE WARNED THAT EVEN IF YOU FAIL TO APPEAR AT THE SCHEDULED HEARING, THE HEARING WILL GO ON WITHOUT YOU AND YOUR RIGHTS TO YOUR CHILD MAY BE ENDED BY THE COURT WITHOUT YOUR BEING PRESENT. YOU HAVE A RIGHT TO BE REPRESENTED AT THE HEARING BY A LAWYER. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP.
LAWYER REFERRAL SERVICE
The Allegheny County Bar Association
920 City-County Building
Pittsburgh, PA 15219
(412) 261-2088__________Name of Attorney
Address
Telephone Number(2) Notice to the Other Parent of Hearing on Petition to Confirm consent and Terminate Parental Rights.
(Caption of Case) TO: (name of other parent) , MOTHER/FATHER/
LEGAL FATHER OF (adoptee's name) , BORN ON THE ____ DAY OF ______ , ____ , AT (hospital) , (city) , (county) , (state) .A PETITION HAS BEEN FILED ASKING THE COURT TO PUT AN END TO ALL RIGHTS (parent's name) HAS TO YOUR CHILD, (name of Adoptee) . THE COURT HAS SET A HEARING TO CONSIDER ENDING HIS/HER RIGHTS TO YOUR CHILD. THAT HEARING WILL BE HELD IN ORPHANS' COURT, 1700 FRICK BUILDING, 437 GRANT STREET, PITTSBURGH, PENNSYLVANIA ON ______ , ____ AT ____ __ .M. A COPY OF THE NOTICE TO (parent's name) IS ATTACHED HERETO.
__________Name of Attorney
Address
Telephone Number(3) Notice to Putative Father whose rights may be terminated pursuant to 23 Pa.C.S.A. Section 2504(c).
TO: (name of putative father) , FATHER OF (adoptee's name) , BORN ON THE ____ DAY OF ______ , ____ , AT (hospital) , (city) , (county) , (state) .
A PETITION HAS BEEN FILED ASKING THE COURT TO PUT AN END TO ALL RIGHTS (parent's name) HAS TO YOUR CHILD, (name of Adoptee) . THE COURT HAS SET A HEARING TO CONSIDER ENDING HER RIGHTS TO YOUR CHILD. THAT HEARING WILL BE HELD IN ORPHANS' COURT, 1700 FRICK BUILDING, 437 GRANT STREET, PITTSBURGH, PENNSYLVANIA ON ______ , ____ AT ____ __ .M. A COPY OF THE NOTICE TO (parent's name) IS ATTACHED HERETO.
THIS PETITION ALSO ASKS THE COURT TO PUT AN END TO ALL RIGHTS YOU HAVE TO YOUR CHILD (adoptee's name) . YOU ARE WARNED THAT IF YOU
FAIL TO FILE EITHER AN ACKNOWLEDGEMENT OF PATERNITY OR CLAIM OF PATERNITY PURSUANT TO 23 Pa.C.S.A. SECTION 5103 AND YOU FAIL TO APPEAR AT THIS HEARING FOR THE PURPOSE OF OBJECTING TO THE TERMINATION OF YOUR RIGHTS OR YOU FAIL TO FILE A WRITTEN OBJECTION TO THE TERMINATION OF YOUR RIGHTS WITH THE COURT PRIOR TO THIS HEARING, THE HEARING WILL GO ON WITHOUT YOU BEING PRESENT. YOU HAVE A RIGHT TO BE REPRESENTED AT THE HEARING BY A LAWYER. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP.
LAWYER REFERRAL SERVICE
The Allegheny County Bar Association
920 City-County Building
Pittsburgh, Pennsylvania 15219
(412) 261-2088__________Name of Attorney
Address
Telephone Number(4) Notice to Parent(s) or Guardian(s) of Parent who has not reached the age of 18 years.
(Caption of Case) TO: (name) , MOTHER/FATHER OF (name of
parent) , MINOR FATHER/MOTHER OF (adoptee's name) , BORN ON THE ____ DAY OF ______ , ____ , AT (hospital) , (city) , (county) , (state) .A PETITION HAS BEEN FILED ASKING THE COURT TO PUT AN END TO ALL RIGHTS (name of minor natural parent) HAS TO (HIS/HER) CHILD (adoptee's name) . THE COURT HAS SET A HEAR-
ING TO CONSIDER ENDING (HIS/HER) RIGHTS TO (HIS/HER) CHILD. THAT HEARING WILL BE HELD IN ORPHANS' COURT, 1700 FRICK BUILDING, 437 GRANT STREET, PITTSBURGH, PENNSYLVANIA ON ______ , ____ AT ____ __ .M. A COPY OF THE NOTICE TO (parent's name) IS ATTACHED HERETO.__________Name of Attorney
Address
Telephone Number(d) Final Decree. A decree of termination in substantially the following form shall be submitted to the Court at the Hearing:
(1) DECREE
AND NOW, this ____ day of ______ , ____ , the foregoing Petition to Confirm Consent to Adoption having come on to be heard, upon consideration thereof and the consent attached thereto executed by (name of parent) , (mother/father) of (adoptee's name) , and it appearing that (name of parent) has failed for a period in excess of forty (40) days after executing the aforesaid consent to file or proceed with a Petition for Voluntary Relinquishment of Parental Rights, the Court finds that the facts averred in said petition are true and that the prayer of the petition should be granted;
NOW, THEREFORE IT IS ORDERED AND DECREED that the Consent to Adoption of (adoptee's name) executed by (parent's name) be and is hereby confirmed in accordance with the Adoption Act, 23 Pa.C.S.A. Section 2504 and the parental rights of (parent's name) to (adoptee's name) be and are hereby terminated; said termination to extinguish the power or the right of said natural parent to object to or receive notice of adoption proceedings;
AND IT IS FURTHER ORDERED AND DECREED that custody of (adoptee's name) be and is hereby awarded to (agency name, or adopting parent(s) name(s) if non-agency adoption) .
BY THE COURT:
______ , J
(2) If the rights of the putative father will also be terminated pursuant to 23 Pa.C.S.A. Section 2504(c), then a decree in substantially the following form shall be submitted to the Court at the hearing:
AND NOW, this ____ day of ______ , ____ , the foregoing Petition to Confirm Consent to Adoption having come on to be heard, upon consideration thereof and the consent attached thereto executed by (parent's name) , (mother/father) of (adoptee's name) , and it appearing that (parent's name) has failed for a period in excess of forty (40) days after executing the aforesaid consent to file or proceed with a Petition for Voluntary Relinquishment of Parental Rights, the Court finds that the facts averred in said petition are true and that the prayer of the petition should be granted:
NOW, THEREFORE IT IS ORDERED AND DECREED that the Consent to Adoption of (adoptee's name) executed by (parent's name) be and is hereby confirmed in accordance with the Adoption Act, 23 Pa.C.S.A. Section 2504 and the parental rights of (parent's name) to (adoptee's name) be and are hereby terminated; said termination to extinguish the power or the right of said natural parent to object to or receive notice of adoption proceedings;
Furthermore, the Court finds that the putative father, (putative father's name) , will not execute a consent to an adoption as required by 23 Pa.C.S.A. Section 2711, has not filed an Acknowledgment of Paternity or Claim of Paternity pursuant to 23 Pa.C.S.A. Section 5103, has not appeared to object to the termination of his parental rights to said child, and has not filed a written objection with this Court to the termination of his parental rights to said child;
NOW, THEREFORE, it is ORDERED AND DECREED that the parental rights of the putative father, (putative father's name) , with respect to said child are hereby terminated in accordance with 23 Pa.C.S.A. Section 2504(c); said termination to extinguish the power or right of said (putative father's name) to object to or receive notice of Adoption proceedings;
IT IS FURTHER ORDERED AND DECREED that custody of (adoptee's name) is hereby awarded to (agency, or adopting parent's name(s) if non-agency adoption .
BY THE COURT:
______ , J
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