This is a private record.
Name
Address
City, State, Zip
Phone
Email
I am the[ ] Petitioner
[ ] Attorney for thePetitionerand my Utah Bar number is ______
In the District Court of Utah
______Judicial District______County
Court Address ______
In the Matter of the Adoption of
______
(adoptee’s name) / Certificate of Readiness for Adoption Hearing
______
Case Number
______
Judge
______
Commissioner (domestic cases)

(1)The following documents have been filed with the court or are not required:

  • Petition to Adopt a Minor Stepchild has been filed
  • Adoptee’s Consent and Waiver of Rights

[ ] has been filed

[ ] is not required

  • Non-custodial Parent’s Consent and Waiver of Rights

[ ] has been filed

[ ] is not required

  • Adoptee’s Guardian’s Consent and Waiver of Rights

[ ] has been filed

[ ] is not required

  • Death certificate or other evidence of death of any deceased person whose consent to the adoption is required

[ ] has been filed

[ ] is not required

  • Adoptee’s Guardian’s Waiver of Rights(No right to consent)

[ ] has been filed

[ ] is not required

  • Adoptee’s Custodian’s Waiver of Rights

[ ] has been filed

[ ] is not required

  • Adoptee’s Spouse’s Waiver of Rights

[ ] has been filed

[ ] is not required

  • Report of Adoption form for the Office of Vital Records and Statistics

[ ] has been filed

[ ] is not required

  • Criminal History Report by the Bureau of Criminal Identification

[ ] has been filed

[ ] is not required

  • Child Abuse History Report by the Division of Child and Family Services

[ ] has been filed

[ ] is not required

  • Certificate of PaternitySearch

[ ] has been filed

[ ] is not required

  • Written evidence from the United States Citizenship and Immigration Services if the adoptee is an “alien child” under 16 years old

[ ] has been filed

[ ] is not required

(2)The Petition to Adopt a Minor Stepchild is at issue and is ready for a hearing.

(3)I ask that the court schedule the Petition to Adopta Minor Stepchild for a hearing.

I declare under criminal penalty under the law of Utah that everything stated in this document is true.
Signed at ______(city, and state or country).
Signature ►
Date / Printed Name
Certificate of Readiness for Adoption Hearing / Approved Board of District Court Judges December 17, 2010
Revised May 8, 2018 / Page 1 of 3