ADOPT-230
Clerk stamps date here when form is filed.
Adoption Expenses
If you are adopting your stepchild, do not fill out this form. 1 Your name (adopting parent): a. b. Relationship to child: Address (skip this if you have a lawyer): Street: State: Zip: City: ) Telephone number: ( Lawyer (if any): (Name, address, telephone number, and State Bar number):
Fill in court name and street address:
Superior Court of California, County of
Fill in case number if known:
Case Number:
2
Name of child after adoption:
3
List the services you received that were related to the adoption of the child listed in 2 :
Service
a. Hospital
Name and address of service provider
How much paid, or value of service
$
Payment date
b. Prenatal care
$
c. Legal fees paid
$
d. Adoption agency fee paid e. Transportation
$
$
f. Adoption facilitator fees paid
$
Judicial Council of California, www.courtinfo.ca.gov Revised January 1, 2007, Mandatory Form Family Code, ยง 8610
Adoption Expenses
ADOPT-230, Page 1 of 2
American LegalNet, Inc. www.FormsWorkflow.com
Case Number:
Your name: How much paid, or value of service
$
Service
g. Counseling fees paid
Name and address of service provider
Payment date
h. Adoption service provider i. Pregnancy expenses paid j. Court filing fees paid
$
$
$
k. Fingerprinting fees paid l. Other
$
$
If you need more space, attach a sheet of paper and write "ADOPT-230, Item 3--Payment for Services" at the top. Number of pages attached: 4 I declare under penalty of perjury under the laws of the State of California that I have listed all payments (or anything of value) that I have paid or agreed to pay, or that were paid on my behalf, related to the child I want to adopt. I declare under penalty of perjury under the laws of the State of California that the information in this form is true and correct, which means that if I lie on this form, I am guilty of a crime.
Date:
Type or print your name Signature of adopting parent
Date:
Type or print your name Signature of adopting parent
Revised January 1, 2007
Adoption Expenses
ADOPT-230, Page 2 of 2