The judge believes the adoption is in the child’s best interest and orders this adoption.
The child’s name after adoption will be:
The adopting parent or parents and the child are now parent and child under the law, with all the rights and duties
of the parent-child relationship or, in the case of a tribal customary adoption, all the rights and duties set out in the
tribal customary adoption order and Welfare and Institutions Code section 366.24.
Clerk’s Certificate of Mailing
For the adoption of an Indian child, the Clerk certifies:
I am not a party to this adoption. I placed a filed copy of:
in a sealed envelope, marked “Confidential” and addressed to:
Chief, Division of Social Services
Bureau of Indian Affairs
1849 C Street, NW
Mail Stop 310-SIB
Washington, DC 20240
The envelope was mailed by U.S. mail, with full postage, from:
Revised July 1, 2013
The child’s name before adoption was:
before adoption be listed on this order. (Fam. Code, § 8714.5(g).)
tribe dated containing pages and attached hereto is fully incorporated into this order of adoption.
This is a tribal customary adoption, The tribal customary adoption order of the
(Date of Signature)
This case is an adoption by a relative petitioned under Family Code section 8714.5.
The adopting relative The child, who is 12 or older, has requested that the child’s name
The child is an Indian child. The judge finds that this adoption meets the placement requirements of the
Indian Child Welfare Act or that there is good cause to give preference to these adopting parents. The clerk
will fill out below.
The judge approves the Contact After Adoption Agreement (ADOPT-310)
As amended on ADOPT-310As submitted
This is an adoption under the Hague Adoption Convention. Verification of Compliance with Hague Adoption
Convention Attachment (form ADOPT-216) is attached and fully incorporated into this order.
The judge believes it will serve public policy and the best interest of the child to grant the request of the
adopting parent or parents for the court to make this order effective as of (date): .
Judge (or Judicial Officer)
Clerk will fill out section below.
Adoption Request (ADOPT-200)
Adoption Order (ADOPT-215)
Adoption of Indian Child (ADOPT-220)
Contact After Adoption Agreement (ADOPT-310)
ADOPT-215, Page 2 of 2
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