______County,
Tennessee / FINAL ORDER OF ADOPTION / Case Number
______
Petitioner(s) Respondent(s)
This case was heard on ______[date]. The Petition is hereby incorporated into this Decree. On the basis of the Petition and the testimony offered in this proceeding, the Court makes the following findings:
FINDINGS OF FACT
The Court makes the following findings of fact:
1. The full name of the person being adopted is ______.
2. The full names of the Petitioner(s) are ______.
3. The county of residence of the Petitioner(s) is ______.
4. Petitioner ______q is q is not a stepparent of the person being adopted.
5. Petitioner ______q is q is not a stepparent of the person being adopted.
6. The Petition was filed in this court on ______, 20___.
7. The Petitioner(s) acquired physical custody of the child on ______, 20___.
8. The Petitioner(s) acquired physical custody of the child from the following person or agency or by the following court order:
______.
9. A guardianship order [specify which] q was entered in this court on ______, 20___ q was not entered.
10. The following have been filed in the court record: [check all that apply]
q order(s) reflecting the termination of parental rights pursuant to actions filed by the prospective adoptive parents
q order(s) confirming parental consents, or the consents of the Department of Children’s Services or a licensed child-placing agency with authority to place and consent to the child's adoption
q the consent of the child, who is over 14 years of age
q the consent of the guardian ad litem of an incompetent adult or mentally disabled child or of any other person or entity required by law to be filed
11. All persons entitled to notice of the proceedings have been served with process, and all necessary parties are properly before the court. The following have taken part in the proceedings: ______.
12. The time for answering the Petition has expired.
13. [Complete if no prior order terminating all parental rights has been entered.] In determining whether termination of parental or guardianship rights is in the best interest of the child, the court has considered the following: [check all that apply]
q Whether the parent or guardian has made such an adjustment of circumstance, conduct, or conditions as to make it safe and in the child's best interest to be in the home of the parent or guardian.
q Whether the parent or guardian has failed to effect a lasting adjustment after reasonable efforts by available social services agencies for such duration of time that lasting adjustment does not reasonably appear possible.
q Whether the parent or guardian has maintained regular visitation or other contact with the child.
q Whether a meaningful relationship has otherwise been established between the parent or guardian and the child.
q The effect a change of caretakers and physical environment is likely to have on the child's emotional, psychological and medical condition.
q Whether the parent or guardian, or other person residing with the parent or guardian, has shown brutality, physical, sexual, emotional or psychological abuse, or neglect toward the child, or another child or adult in the family or household.
q Whether the physical environment of the parent's or guardian's home is healthy and safe, whether there is criminal activity in the home, or whether there is such use of alcohol or controlled substances as may render the parent or guardian consistently unable to care for the child in a safe and stable manner.
q Whether the parent's or guardian's mental and/or emotional status would be detrimental to the child or prevent the parent or guardian from effectively providing safe and stable care and supervision for the child.
q Whether the parent or guardian has paid child support consistent with the child support guidelines promulgated by the Department of Human Services.
q Other [specify]:______.
14. The Petitioner(s) are fit persons to have the care and custody of the child.
15. The Petitioner(s) are financially able to provide for the child.
16. The child is a suitable child for adoption.
17. The adoption is for the best interest of the child.
18. There [specify which] q has q has not been filed an affidavit by an attorney for the Petitioner(s) detailing the fees charged for any services rendered in the placement of the child or for legal services, and any fees paid by the attorney to any other person or entity for services rendered in securing the placement of the child or for providing any services related to securing any home studies to secure a surrender or adoption of the child.
19. There [specify which] q has q has not been filed an affidavit by the licensed child-placing agency or licensed clinical social worker that or who placed the child with the Petitioner(s) regarding the fees charged by such agency or social worker to the adoptive parents for the placement of the child and for any home studies and supervision of the placement conducted by the licensed child-placing agency or by the licensed clinical social worker.
20. Other: ______.
CONCLUSIONS OF LAW
21. q Because the child is related to the Petitioner(s), the Court may waive the six-month waiting period, the orders of reference, the preliminary home study and home study, the order of guardianship or custody, and the final court report, and may proceed to immediately grant a Final Order of Adoption.
22. q Because the child has already resided in the home of the Petitioner(s) for six months, because the Court has received the final report concerning the circumstances of the child and the Petitioner(s), and because the Court is satisfied that the adoption will be in the best interest of the child, the Court may waive the six-month waiting period after the filing of the Petition and may enter a Final Order of Adoption.
23. q Because this proceeding involves re-adoption, a Final Order of Adoption may be entered before the home study has been filed with the court, before the Petition has been on file at least six months, and before a final report is filed with the court.
24. q The child has been brought into Tennessee from another state or foreign country. There has been compliance with the Interstate Compact on the Placement of Children, if applicable, or with the requirements of the foreign government or legal authorities in the foreign country for the Petitioner(s) to have custody of the child and with all requirements of the United States government for the immigration of the child to this country, unless good cause has been shown to excuse such compliance.
25. q Termination of all necessary parental or guardian rights to the child by court order, or all necessary surrenders or parental consents, have occurred.
26. q The child's adoption is subject to and in compliance with the provisions of the Indian Child Welfare Act.
27. q The child has been the subject of an adoption decree in a foreign country in which the Petitioner(s) were given the child in adoption by such decree.
28. q This adoption is a re-adoption for the purpose of complying with the immigration or naturalization requirements of the United States Government.
29. Other: ______.
IT IS, THEREFORE, ORDERED THAT:
1. The parental rights of ______are herby terminated. [Complete only if parental rights have not been have previously terminated.]
2. The relationship of parent and child is established between the Petitioner(s) and the child.
3. The name of the child is changed to ______.
4. The clerk of the court shall furnish the Department of Children’s Services a certified copy of this Order and any affidavits described in it. The Department shall record pertinent information from the Order, and the Department shall maintain a copy of the Order with all other information in the sealed adoption record.
5. This Order of Adoption shall be reported by the clerk to the Division of Vital Records of the Department of Health by sending a certified copy of this Order to the Registrar of the Division of Vital Records for preparation of a new Certificate of Birth by adoption or for a Report of Foreign Birth.
6. The Clerk of this Court shall supply the Registrar of the Division of Vital Records with the information required by statute for the preparation of a Report of Foreign Birth if the child was born in a foreign country.
7. The fees of the attorney for the Petitioner(s) [select one] q are approved q shall be reduced by $______and reimbursed to the Petitioner(s).
8. The fees of the licensed child-placing agency or licensed clinical social worker that or who placed the child with the Petitioner(s) [select one] q are approved q shall be reduced by $______and reimbursed to the Petitioner(s).
9. Court costs are taxed against the Petitioner(s).
10. Other: ______.
Enter:
Judge or Chancellor
Presented by:
______
Party Submitting Order
Address: ______
______
Telephone: ______
Fax: ______
Email: ______Email: ______
______
Other Party [if there is agreement by the parties]
Address: ______
______
Telephone: ______
Fax: ______
E-Mail: ______
CERTIFICATE OF SERVICE OF PROPOSED ORDER [if no agreement]
I served a copy of the foregoing upon the following persons at the following addresses:
I did so on or before the date below by personal delivery or by U.S. Mail.
Dated: ______
Party Submitting Order
CLERK’S CERTIFICATE OF SERVICE OF FINAL ORDER
I certify a copy of this Order was served upon the following persons at the following addresses:
Dated: ______
Deputy Clerk
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