(Attach to Adoption Order (form ADOPT-215) in cases proceeding under
the Hague Adoption Convention.)
The court finds as follows:
Verification of Compliance with Hague
Adoption Convention Attachment
Clerk stamps date here when form is filed.
Superior Court of California, County of
Court fills in case number when form is filed.
All parental rights have been terminated and the child has been declared free from the custody and control of his
or her parents; thus, the child is adoptable. (Convention, art. 4(a).)
ADOPT-216, Page 1 of 2
Judicial Council of California, www.courts.ca.gov
New July 1, 2013, Mandatory Form
Family Code, §§ 8900, 8900.5, 8901, 8902, 8903,
8904, 8905, 8908, 8910, 8911, 8912, 8919, 8924,
8925; 22 Code of Federal Regulations Part 96, § 97.3;
Hague Adoption Convention
Verification of Compliance with
Hague Adoption Convention Attachment
Determination of Application of Hague Adoption Convention
(to be completed by adopting parent(s)):
If applicable, please state the permanent address outside the United
States of the adopting parent(s):
Will you be moving the child to permanently reside in another
If your answer to 1(b) is yes, what is the name of the other country?
If your answer to 1(b) is yes, when will the move occur?
Has the child lived in any other country since his/her birth?
If your answer to 1(e) is yes, please indicate the country and the length of time the child resided there.
(length of time resided in country):
What is the child's citizenship?
Please state date(s) for any contact between the prospective adoptive parent(s) and the child's birth parent(s) or
any other person who has had care of the child and describe the contact:
Please state the amount and purpose of any payments made by the adopting parent(s) to the birth parent(s)
or any other person who has had care of the child:
Court Findings (to be completed by the judge)
The Hague Adoption Convention applies to this adoption.