*Order 'instantly' on line:
Order your documents 3 ways
with this one form:
1. Online instant ordering
with credit card payment;
2. Faxing
the form with your choice of payment options; or
3. Point, Click & Print the form
for 'snail' mailing or faxing to our office.
Documents are return e-mailed
to you as attachments within 72 hours [Most
within*48 hours] of receipt of order and verification of payment.
Your information will be held in the strictest confidence. We do not 'sell' our customer's names or information to 'mailing lists' or 'marketers', and do not release any information to anyone other than the customer without prior written consent from the customer.
What is your (the adopting
Mother's) full legal name?
What is your social security
number?
What is the
state and number of your driver's license?
What is your date of
birth?
How old are you?
What is your
address?
Street Address
City
County, State, Zip
Your E-mail address
Your Telephonenumber [include area code]
Are you in the Military?
No
Yes
Name of Employer:
What is theadopting father's full legal name?
What is the
father's social security number?
What is the state and number of the adopting father's driver's
license?
What is the adopting father's date of birth?
How old is adopting father?
Is adopting Father in the Military?
No Yes
How long has/have the child/children
resided with the adopting parents?
What is the biological father's full legal
name?
father's date of birth?
father's
Age?
State and number
of driver's license?
What is the Parent's address?
Street Address
City
County, State, Zip
Telephone number [include area code]
What is the biological mother's full legal
name?
mother's date of birth?
mother's
Age?
State and
number of driver's license?
What is the Parent's address?
BIOLOGICAL FATHER'S STATUS:
Street Address
City
County, State, Zip
Telephone number [include area code]
Name of Employer (if known)
Is the Parent in the Military?
No Yes
Father is on child's birth
certificate Is the biological parent consenting to
termination of his/her parental rights?
Probable Father
Presumed Father
(Parent's were married BUT Father is NOT on birth certificate)
Father is unknown
Parental rights already terminated
Yes
No
Are the whereabouts of the biological
parent unknown (missing)?
Yes
No
Is the biological parent deceased (must
have death certificate)?
Yes
No
Date of
Death?
Place of Death?(City/State)
Were the natural parents ever
married?
Yes
No
What date were you married to the natural father?
What City were you married in?
What State were you married in?
What date where you divorced?
HOW DO YOU WANT THE BIOLOGICAL FATHER
"SERVED" (NOTIFIED)?
He is agreeing to the adoption (no
service required)
His parental rights have already
been terminated (no service
required)
He is deceased (no service
required)
Service By Sheriff
Service By
Certified Mail
Service By Publication (Identity Unknown or Whereabouts Unknown (Missing))
CHILD(REN)'S INFORMATION:
Child's Name
Date of Birth Child's Age
Male Female
Place of Birth?
(City/State)
Social Security Number
Child's Name
Date of Birth
Child's Age
Male
Female
Place of Birth?
(City/State)
Social
Security Number
Child's Name
Date of Birth
Child's Age
Male
Female
Place of Birth?
(City/State)
Social Security Number
ARE THERE ANY COURT ORDERS ON ANY OF THE
ABOVE CHILDREN?
Yes
No
IF YES - PROVIDE THE FOLLOWING:
Title of Order (i.e.Agreed Final Decree of Divorce)
County and State where order was issued
Court that issued the order
(i.e. 810th District, County Court etc.)
Case/Order Number
Date order was issued
Does the mother have joint or sole physical
custody?
No court orders for custody
Mother is Joint Managing Conservator
Mother is Sole
Managing Conservator
Where the father's parental rights terminated
by the court?
Yes
No
Is the father court ordered to pay child
support?
Yes
No
If Court ordered; child support is:
None: There
is no court order for child support
Current (paid as ordered)
Delinquent in
the amount of
Never paid any
child support even though court ordered
Does the father have court ordered
visitation?:
No: There is no court ordered visitation
Yes: Father has
visitation
Yes:
Father has only supervised visitation
INFORMATION ABOUT REASON FOR TERMINATION OF
THE BOILOGICAL PARENT'S RIGHTS AND ADOPTION:
[SELECT ANY
OR ALL OF THE APPLICABLE GROUNDS (from the Texas Statutes):
that the parent has:
(A)voluntarily left the child alone or in the possession of another
not the parent and expressed an intent not to return;
voluntarily left the child alone or in the possession of another not the parent without expressing an intent to return, without providing for the adequate support of the child, and remained away for a period of at least three months;
voluntarily left the child alone or in the possession of another without providing adequate support of the child and remained away for a period of at least six months;
knowingly placed or knowingly allowed the child to remain in conditions or surroundings which endanger the physical or emotional well-being of the child;
engaged in conduct or knowingly placed the child with persons who engaged in conduct which endangers the physical or emotional well-being of the child;
failed to support the child in accordance with the parent's ability during a period of one year ending within six months of the date of the filing of the petition;
abandoned the child without identifying the child or furnishing means of identification, and the child's identity cannot be ascertained by the exercise of reasonable diligence;
voluntarily, and with knowledge
of the pregnancy, abandoned the mother of the child beginning at a time during
her pregnancy with the child and continuing through the birth, failed to provide
adequate support or medical care for the mother during the period of abandonment
before the birth of the child, and remained apart from the child or failed to
support the child since the birth; contumaciously refused to submit to a
reasonable and lawful order of a court under Chapter 264 ; been the major cause
of:
executed before or after the suit is filed an unrevoked or irrevocable affidavit of relinquishment of parental rights as provided by the Texas Family Code;
been convicted or has been placed on community supervision, including deferred adjudication community supervision, for being criminally responsible for the death or serious injury of a child under the following sections of the Penal Code or adjudicated under Title 3 for conduct that caused the death or serious injury of a child and that would constitute a violation of one of the following Penal Code sections:
Does the biological father visit or provide
support for the child(ren)?
Explain how much support and how often he visits
the children, etc.:
Why do you want to have parental rights
terminated?
ie: parent has drug or alcohol addiction (give details ie: how
long addiction, parent is in jail, parent is on probation/parole and what for -
when etc.
Is/was the parent abusive to the child when
the child is with them?
explain when, where, how:
Is/was the child neglected when with the
parent(s)?
Explain how example: didn't go to school, left alone, around drugs
and addicts etc.
Does the child use the step-father's
surname "informally"?
Yes
No
Does the child consider the step-parent
to be "Daddy" ?
Yes No
IF THE WHEREABOUTS OF THE FATHER ARE UNKOWN:
TO HAVE A PARENT NOTIFIED BY PUBLICATION - WHEN THEY ARE "MISSING", You must have made an honest effort to locate them and tell the court what you have done. example: "I have called his mother but she hasn't heard from him in 6 months, or his mother has moved and is not listed in the directory. I have called the last place he was employed but he is gone and left no forwarding. I have contacted all of his relatives and friends but no body knows where he is. I have checked the phone directories in the area and he's not in it.
LIST EVERYTHING THAT YOU HAVE TRIED TO FIND THE PERSON: What you have done to find the person:
Please type where indicated, the address you want your
completed forms return mailed via US Postal.
Name
Mailing Address
City
State
Zip Code
E-mail Address #1
E-mail Address #2
Daytime
Telephone Number
Evening Telephone
Number
Completed forms are available for fastest delivery by return e-mail attachment in their original Word Perfect format or Adobe (.pdf) [portable document format.] MS Word 'claims' to convert word perfect files, however, legal documents often have a complex format that does not convert correctly resulting in formatting errors. (See Important Note to Non-Word Perfect Users Below):
**Important Note to non-Word Perfect users: Due to the infinite number of possible problems with file conversions, (from the originating word perfect format), i.e. required state form formatting requirements etc., and subsequent file transfer problems beyond our control, WE CANNOT GUARANTEE the formatting accuracy, integrity of files, or the DELIVERY VIA FILE TRANSFER IN ANY FORMAT OTHER THAN THE ORIGINATING WORD PERFECT (for use in Word Perfect), OR ADOBE . (We'll certainly do our best - but we cannot guarantee the integrity of MS Word (.doc) or (.rtf) format conversions). If you should have problems with a file transfer , just let us know and we'll be glad to send out a hard copy ASAP !
Select the format for file transfer below.
Payment Method:
I will pay for
my paperwork by:
Credit Card (information below)
Mailing In My Check, Money Order or Cashier's
Check
Return mail my signature ready
paperwork by:
e-mail attachment to the following e-mail
address:
Overnight
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surcharge)
Priority US
Postal Shipping [2-3 day delivery] ($5 surcharge)
1st Class U.S. Postal to the above mailing address. [no
additional surcharge]
Checking Account Debit Card
(MasterCard & Visa only)
*You may use
your MasterCard or Visa checking Account Debit Card by completing the following
credit card information. This will allow your checking account to be debited and
processing to be done immediately.
Which Credit Card Will You Be
Using?
MasterCard
VISA
Credit Card Number/3 digit
code on back
Expiration
Date
Card Holder's Name (as it
appears on the card)
Street Address (As it
appears on the card)
City/State (As it appears
on the card)
Zip code [As it appears on the card]
Charge my credit card in the amount of:
NON-TEXAS RESIDENTS
$250.00 plus $100.00 for each
additonal child [*includes
delivery by e-mail or 1st Class US Postal]
TEXAS
RESIDENTS: [Includes TX state sales tax of $12.29 included
below]
$262.29 plus $100.00 for each additonal child
[*includes delivery by e-mail or 1st Class US
Postal]
If you wish to use pay pal for your payment,:
If you wish to mail your payment,please make check or money order payable to:
National Divorce & Bankruptcy Center Center
3037 F
Cunningham Drive, Wichita Falls, Texas 76308
Phone: (940)
337-4129