Petition and Agreement of Adult Adoption PC-603A PAGE 1 OF 3

Petition and Agreement C O N N E C T I C U T P R O B A T E C O U R T Sof Adult Adoption PC-603A REV. 1/18

CONFI DENTIAL

RECEIVED:

Instructions: 1) An adult person may use this form to petition for approval of an agreement to adopt another adult who is younger in age, provided that the person to be adopted is not the spouse, brother, sister, uncle or aunt of the proposed adoptive parent, whether of the whole or half blood.

2) The Agreement of Adult Adoption contained in this petition must be signed by the proposed adoptiveparent (s) and the adult to be adopted.

3) One parent of the adult to be adopted may join in the adoption agreement between the parent’s spouseor one other person and the adult child. The rights of a parent who does not join in the adoption agreement will be terminated in accordance with subdivisions (5), (6) and (7) of C.G.S. section 45a-731.

4) The petition must be filed in the probate district in which the adoptive parent resides. If the adoptiveparent does not reside in Connecticut, the petition should be filed in the district in which the adult to be adopted resides.

5) For further information, see C.G.S. sections 45a-731 and 45a-734.6) Type or print the form in ink. Use an additional sheet or Second Sheet, PC-180, if more space is needed.

Probate Court Name District Number

In the Matter of (Name, address and telephone number of the adult to be adopted.) Date and place of birth of adult to be adopted

Hereinafter referred to as the adult to be adopted. Proposed adoptive parent(s) (Name, address, telephone number and date of birth of each proposed adoptive parent.)

Parent of adult to be adopted joining in the adoption agreement, if any, as addressed in Instruction No. 3 above (Name, address and telephone number.)

Spouse of proposed adoptive parent, if not a parent or proposed adoptive parent (Name, address and telephone number.)

Other persons interested in the welfare of the proposed adoptive parent(s) or adult to be adopted to whom notice of this petition should be given (Name, address and telephone number of each person.)

Petition and Agreement of Adult Adoption PC-603A PAGE 2 OF 3

Petition and Agreement of Adult Adoption

C O N N E C T I C U T P R O B A T E C O U R T S

PC-603A REV. 1/18 CONFIDENTIAL Adoption Agreement

The proposed adoptive parent(s), __________________________________________________________________,

agree(s) to adopt _______________________________________,an adult who is younger than the adoptive parents.

___________________________________, being over the age of 18, agrees to be adopted by the proposed adoptive parent(s). The person to be adopted is not the spouse, brother, sister, uncle or aunt of the proposed adoptive parent, whether of the whole or half blood. The proposed adoptive parent(s) and the adult to be adopted share a relationship that is similar to that between a parent and an adult child.

There are two proposed adoptive parents.

There is one proposed adoptive parent.

The proposed adoptive parent is married to:

a parent of the adult to be adopted. The parent is joining in the adoption agreement and does not relinquish any parental rights in and to the adult to be adopted. (See Instruction No. 3 above.)

a spouse who is not a parent of the adult to be adopted. The spouse is consenting to the adoption agreement.

a spouse who is not a parent of the adult to be adopted. The spouse is not consenting to the adoption agreement for the following reasons:

The proposed adoptive parent is not married.

The parent of the adult to be adopted is not married to the proposed adoptive parent but is joining in the adoption agreement and does not relinquish any parental rights in and to the adult child. (See Instruction No. 3 above.)

WHEREFORE, THE PARTIES TO THE ADULT ADOPTION AGREEMENT REQUEST that the court: Approve the adult adoption agreement between the proposed adoptive parent (s) and the adult to be adopted.

Change the name of the adult to be adopted to______________________________.

Amend the birth certificate of the adult to be adopted.

The representations made in this petition are made under the penalty of false statement.

P A R T I E S T O T H E A G R E E M E N T Signature of Adult to be Adopted

Type or Print Name

Date

Signature of Proposed Adoptive Parent

Type or print name

Date

Signature of Proposed Adoptive Parent

Type or print name

Date

Petition and Agreement of Adult Adoption PC-603A PAGE 3 OF 3

Petition and Agreement of Adult Adoption

C O N N E C T I C U T P R O B A T E C O U R T S

PC-603A REV. 1/18 CONFIDENTIAL PARTIES TO THE AGREEMENT(Continued)

PARENT OF ADULT CHILD JOINING IN AGREEMENT

Signature of Parent of Adult Child

Type or print name

Date

SPOUSE OF PROPOSED ADOPTIVE PARENT CONSENTING TO AGREEMENT (IF NOT PARENT OF ADULT TO BE ADOPTED)

Signature of Spouse of Proposed Adoptive Parent

Type or print name

Date