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Here is the text we could read:

This is a tier 2 case. 

 

If you do not respond to this 
document within applicable time 
limits, judgment could be entered 
against you as requested. 

 
Check your email. You will receive information and 
documents at this email address.  

ity, State, Zip 

 
Name 
 
Address 

hone 

 
Email 

  C

  P

I am the 

[  ] Petitioner 
[  ] Attorney for the Petitioner and my Utah Bar number is _________ 

In the District Court of Utah 

__________ Judicial District ________________ County 

Court Address ______________________________________________________ 

In the Matter of the Adoption of 

Petition to Adopt a Minor Stepchild 

_____________________________________ 
(adoptee’s name) 

_______________________________ 
Case Number 

_______________________________ 
Judge 

_______________________________ 
Commissioner 

Instructions:  
  You must complete this form before you file it. Court staff cannot complete this form for you. 
  Keep a copy of all documents for your records. 
  Attend all court hearings. 
  Attach the following:  

o  Additional pages as needed to complete paragraphs that don’t have enough space. Write the 

paragraph number on the additional page. 

o  Consent to Adoption and Waiver of Rights signed by any people who have the right to consent to 

o  Waiver of Rights signed by any people who have the right to notice of the proceedings but not the 

o  Death certificate or other evidence of death of any deceased person whose consent to the 

the adoption 

right to consent 

adoption is required 

o  Report of Adoption for the Office of Vital Records and Statistics 
o  Criminal History Report from the Bureau of Criminal Identification 
o  Child Abuse History Report from the Division of Child and Family Services 

Petition to Adopt a Minor Stepchild 

Approved Board of District Court Judges December 17, 2010 
Revised February 8, 2021 

Page 1 of 6 

 

(1) 

The co-petitioners want _______________________________ (name of adopting 

parent) to adopt _________________________________ (adoptee’s current name). 

(2) 

Utah has jurisdiction under Utah Code Section 78B-6-105. 

(3) 

The case is properly filed in this county because (Choose one.) 

[  ]  we reside in this county. 

[  ]  we are not residents of this state, and (Choose all that apply.) 

[  ]  the proposed adoptee was born in this county. 

[  ]  the proposed adoptee resides in this county on the day on which this 
petition is filed. 

[  ]  a parent of the proposed adoptee resides in this county on the day on 
which this petition is filed. 

(4) 

Adoption serves the adoptee’s health, safety, welfare and moral climate and will 
promote the adoptee’s best interests because 

(5) 

The adopting parent is the adoptee’s stepparent. 

(6) 

The adopting parent is married to the adoptee’s custodial parent in a marriage 
that is legally valid and binding. 

(7) 

(Choose one or both.): 

[  ]  The adopting parent is at least 10 years older than the adoptee. 

[  ]  The adopting parent’s spouse is at least 10 years older than the adoptee. 

(8) 

The adoptee was born: (Choose one.) 

[  ]  in Utah. 

[  ]  in a state other than Utah and the requirements of Title 62A, Chapter 4a, Part 
7, Interstate Compact on Placement of Children, have been complied with.  

(9) 

The adoptee has lived in the adopting parent’s home for: (Choose one.) 

[  ]  one year 

Petition to Adopt a Minor Stepchild 

Approved Board of District Court Judges December 17, 2010 
Revised February 8, 2021 

Page 2 of 6 

 

     

[  ]  less than one year, but we request that the court waive the one-year 
requirement because 

(10)  The adoptee is not an Indian child as defined in 25 U.S. Code Section 1903. 

(11)  The adoptee is: (Choose one.) 

[  ]  16 years of age or older. 

[  ]  under 16 and is considered a citizen or national of the United States by the 
United States Citizenship and Immigration Services. 

[  ]  under 16 years of age and is not considered a citizen or national of the 
United States by the United States Citizenship and Immigration Services. (Attach 
written evidence from the United States Citizenship and Immigration Services showing that the 
adoptee was admitted into the United States for permanent residence, was admitted into the 
United States temporarily in one of the lawful nonimmigrant categories, or was legally paroled into 
the United States.) 

(12)  The pre-placement and post-placement adoptive evaluations are not required 

because the adopting parent is the adoptee’s stepparent and the adopting 
parent’s spouse is the adoptee’s custodial parent. 

(13)  The Bureau of Criminal Identification has conducted a criminal history 

investigation, based on fingerprint identification, about the adopting parent. (Attach 
the Bureau’s report.) 

(14)  The adopting parent has not been convicted of, pleaded guilty to, or pleaded no 

contest to a disqualifying offense under Utah Code 78B-6-117(5). 

(15)  The Division of Child and Family Services has investigated all reports and 
investigations of child abuse, neglect, and dependency about the adopting 
parent. (Attach the Division’s report.) 

WAIVER OF RIGHTS; CONSENT REQUIRED 

(16)  The adoptee: (Choose one.) 

[  ]  has consented to this adoption and waives their rights. (Attach the consent.) 

[  ]  cannot consent because the adoptee is less than 12 years old. 

[  ]  cannot consent because the adoptee lacks the mental capacity to consent. 

(17)  The adoptee’s mother: (Choose one.) 

Petition to Adopt a Minor Stepchild 

Approved Board of District Court Judges December 17, 2010 
Revised February 8, 2021 

Page 3 of 6 

 

   

[  ]  is a co-petitioner. 

[  ]  has died. (Attach photocopy of the death certificate or other evidence of death.) 

[  ]  has consented to this adoption and waives her rights. (Attach the consent.) 

[  ]  has not consented to this adoption and will be served with Notice of Petition 
to Adopt and Notice of Rights. 

[  ]  is not entitled to consent because her parental rights have been terminated. 
(Attach the order terminating parental rights.) 

(18)  The adoptee’s father: (Choose one.) 

[  ]  is a co-petitioner 

[  ]  has died. (Attach photocopy of the death certificate or other evidence of death.) 

[  ]  has consented to this adoption and waives his rights. (Attach the consent.) 

[  ]  has not consented to this adoption and will be served with Notice of Petition 
to Adopt and Notice of Rights. 

[  ]  is not entitled to consent because his parental rights have been terminated. 
(Attach the order terminating parental rights.) 

[  ]  is not entitled to consent because the child was conceived as a result of 
conduct by the father which would constitute a sexual offense described in Title 
76, Chapter 5, Part 4. 

[  ]  is not entitled to consent because: (All must apply.) 

[  ]  he has not fully and strictly complied with the requirements of Utah 
Code Sections 78B-6-121 and 78B-6-122; and 

[  ]  he has not been adjudicated to be the adoptee’s biological father 
before the mother consented to the adoption or relinquished the adoptee 
for adoption; and 

[  ]  he has not signed and filed a voluntary declaration of paternity with the 
state registrar of vital statistics before the mother consented to the 
adoption or relinquished the adoptee for adoption. 

ADOPTEE’S GUARDIAN 

(19) 

[  ]    The adoptee does not have a guardian. 

OR 

[  ]    The adoptee’s guardian: (Choose one.) 

[  ]  has authority to consent, has consented to this adoption, and waives 
their rights. (Attach the consent.) 

Petition to Adopt a Minor Stepchild 

Approved Board of District Court Judges December 17, 2010 
Revised February 8, 2021 

Page 4 of 6 

 

[  ]  has authority to consent, has not consented to this adoption, and will 
be served with Notice of Petition to Adopt and Notice of Rights. 

[  ]  does not have authority to consent, but has waived their right to notice 
and to intervene. (Attach the waiver.) 

[  ]  does not have authority to consent, has not waived their rights to 
notice and to intervene, and will be served with Notice of Petition to Adopt 
and Notice of Rights. 

WAIVER OF RIGHTS; CONSENT NOT REQUIRED 

(20)  The adoptee’s custodian: (Choose one.) 

[  ]  has waived their rights. (Attach the waiver.) 

[  ]  The adoptee does not have a custodian. 

(21)  The adoptee’s spouse: (Choose one.) 

[  ]  has waived their rights. (Attach the waiver.) 

[  ]  has not waived their rights and will be served with Notice of Petition to Adopt 
and Notice of Rights. 

[  ]  has not waived their rights and will be served with Notice of Petition to Adopt 
and Notice of Rights. 

[  ]  The adoptee does not have a spouse. 

REQUEST 

(22)  We request that an Adoption Agreement be executed before this court and that 

the court issue an Adoption Decree declaring that: 

[  ]  the adoptee is adopted by _________________________ (name of adopting 
parent) and is that person’s child; 

[  ]  the adoptee and _________________________ (name of adopting parent) have 
all the rights and duties of the relationship of child and parent; 

[  ]  all rights, duties and responsibilities, including residual parental rights, of any 
person who 

  consented to this adoption,  

 

relinquished the adoptee for adoption,  

  was served with notice of this adoption, or  

  was not entitled to consent to or notice of this adoption 

Petition to Adopt a Minor Stepchild 

Approved Board of District Court Judges December 17, 2010 
Revised February 8, 2021 

Page 5 of 6 

 

are terminated, and such person has no further rights with regard to the 
adoptee;  

[  ]  the adoptee be named ___________________________________________ 
(adoptee’s proposed first, middle, and last name). 

We declare under criminal penalty under the law of Utah that everything stated in this document is true. 

igned at ______________________________________________________ (city, and state or country). 

igned at ______________________________________________________ (city, and state or country). 

Signature ► 

Printed Name Adopting Parent  
(or attorney) 

 

 

Signature ► 

Printed Name Adopting Parent’s Spouse 
(or attorney) 

 

 

 

 

Spousal consent to adoption 

I am the adopting steppparent’s spouse and the adoptee's custodial parent, and I have 
the mental capacity to give consent. 

I understand that if my child is adopted, my child’s non-custodial parent will no longer 
have any parental rights or responsibilities for my child, but that I will continue to have 
full parental rights and responsibilities. I further understand that if my child is adopted by 
my spouse, my spouse will be known as my child's parent and my child will be known 
also as my spouse’s child. 

Understanding all of this, I voluntarily agree that adoption by my spouse promotes my 
child’s best interest, and I voluntarily consent that my child be adopted by my spouse. 

Name of the adopting parent’s spouse 

Sign here ► 

 

 

Petition to Adopt a Minor Stepchild 

Approved Board of District Court Judges December 17, 2010 
Revised February 8, 2021 

Page 6 of 6 

 

  S

  S

Date 

Date 

 
Date

Petition to Adopt a Minor Stepchild

This info page is part of the LIT Lab's Form Explorer project. It is not associated with the Utah state courts. To learn more about the project, check out our about page.

Downloads: You can download both the original form (last checked 2023-03) and the machine-processed form with normalized data fields.

About This Form:

Sourced from legacy.utcourts.gov (2023-03)
Page(s): 6
Fields(s): 156
Average fields per page: 26
Reading Level: Grade 12
LIST Grouping(s): GO-00-00-00-00.

Use our Rate My PDF tool to learn more. Go beyond the above insights and learn more about this or any pdf form at RateMyPDF.com, includes: counts of difficult words used, passive voice decetion, and suggestions for how to make the form more usable.

Identified Data Fields:

We have done our best to automaticly identify and name form fields according to our naming conventions. When possible, we've used names tied to our question library. See e.g., user1_name. If we think we've found a match to a question in our library, it is highlighted in green. Novel names are auto generated. So, you will probably need to edit some of them if you're trying to stick to the convention.

Here are the fields we could identify.

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We've done our best to group similar variables togther to avoid overwhelming the user.

Suggested Screen 0:

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consented_waives_consent__1
cannot_less_years_old
cannot_consent_lacks
page__4
co_petitioner
died_attach_photocopy_death_certificate_evidence
consented_waives_consent__2
consented_notice_petition
entitled_rights_terminated__1
page_check__2
page_check__3
consented_waives_consent__3
page_check__4
entitled_rights_terminated__2
entitled_consent_child
entitled_consent_must_apply
adoptee_guardian
adoptee_guardian_choose_one
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page_field__38
parent_person_child
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page_field__39
page_field__40
adoptee
page__5
authority_consent_consented__2
authority_consent_notice
authority_consent_rights
waived_rights_attach_waiver
waived_rights_notice_petition
adoptee_custodian
page_check__5
page_check__6
adoptee_spouse
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page_check__7
duties_responsibilities_including
terminated_rights_regard
page_field__41
page_field__42
page_field__43
first_middle_last_name
page_field__44
page_field__45
adoptee_named
city_state_country
users1_signature__1
page_field__46
page_field__47
page_field__48
printed_name_adopting_parent
signed
page_field__49
signature_date
page_field__50
page_field__51
page_field__52
page_field__53
page_field__54
page_field__55
page_field__56
page_field__57
page_field__58
page_field__59
attorney
users1_signature__2
page_field__60
page_field__61
page__6
page_check__8

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The Legal Innovation & Technology Lab's Form Explorer Beta @ Suffolk Law School Last updated 2023-04-02

Petition to Adopt a Minor Stepchild

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The Legal Innovation & Technology Lab's Form Explorer ^Beta @ Suffolk Law School Last updated 2023-04-02