AOC-SP-170 — Petition for Independent Adoption

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01 PETITIONER ATTORNEY INFORMATION

Attorney Name *

State Bar No. *

Firm / Office Name

Address *

Phone *

Fax

Email *

02 PETITIONER INFORMATION

Petitioner 1 Full Name *

Petitioner 1 Address *

Petitioner 2 Full Name (for joint petitions — spouse or partner)

Petitioner 2 Address (only if different from Petitioner 1)

County of Filing *

Relationship to Child *

Petitioner Married?

03 CHILD INFORMATION

Child's Full Legal Name *

Date of Birth *

Child's Sex

Child's Current Address *

Child's Race / Ethnicity (optional — statistical purposes only)

Date Child Placed with Petitioner(s) *

04 BIRTH PARENT 1

Birth Parent 1 Full Name *

Current Address

Is Birth Parent 1 Living?

Parental Rights Terminated?

Date of Termination

05 BIRTH PARENT 2

Birth Parent 2 Full Name (leave blank if unknown or not applicable)

Current Address

Is Birth Parent 2 Living?

Parental Rights Terminated?

Date of Termination

06 PLACEMENT & INTERMEDIARY

How was the child placed? *

Intermediary Name

Was any money paid for the placement?

Paid intermediaries are prohibited by NC law. Only reasonable expenses (medical, legal, living) may be reimbursed.

Fee Disclosure / Expenses Paid

07 HOME STUDY & COMPLIANCE

Home Study Completed? *

Home Study Agency

Home Study Date

Post-placement supervision is required for non-relative adoptions under NC law.

Filed within 6 months of placement?

08 CONSENTS OBTAINED

Both birth parent consents obtained in writing and notarized?

Any consent challenged or revoked?

SELECTED COUNTY

— Select above —

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INDEPENDENT ADOPTION RULES

Independent adoption = placed by parent(s), not an agency
NO paid intermediaries allowed under NC law
Home study required for non-relative adoptions
Consents must be in writing and notarized
Petition must be filed within 6 months of placement
Post-placement supervision required
Once finalized, new birth certificate is issued
Legal aid available for low-income families

STATUTORY REFERENCE

G.S. 48-4-101 et seq.Independent adoption

G.S. 48-3-201Consent requirements

G.S. 48-3-301Placement restrictions

G.S. 48-4-1026-month filing requirement

AOC-SP-170Current revision

NEED AN ATTORNEY?

Adoption has many technical requirements — consult an attorney
Barker Richardson, PLLC handles adoption matters in NC
Legal aid available: legalaidnc.org

AOC-SP-170 — Petition for Independent (Non-Agency) Adoption

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INDEPENDENT ADOPTION RULES

STATUTORY REFERENCE

NEED AN ATTORNEY?