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The DSS 5163 form serves as a crucial document in the state of North Carolina for those seeking to adopt an adult, marking a significant step in formally establishing a parental relationship with an individual over the age of 18. This detailed petition requires thorough information from the petitioning parents, including their names, sex, marital status, address, and their relationship to the adoptee. It documents the requisite domicile status in North Carolina for either the adoptee or the petitioners. Detailed within are conditions concerning the adoptee's birthplace, existing familial relationships, and financial assets, especially if the adoptee has been adjudicated incompetent. The form also necessitates the disclosure of any adult children related to the petitioner or the adoptee, shedding light on the broader familial impact of the adoption. A unique aspect of this process is the allowance for the adoptee's name to be changed post-adoption, subject to court approval. By requiring signatures from the petitioners and a notarized acknowledgment, the document underscores the seriousness and legal weight of the process. Prepared in duplicate, the original form finds its home in the Office of the Clerk of Superior Court, with copies sent to the Division of Social Services, ensuring a thorough record within the state's Child Welfare Services. The form, thereby, encapsulates a formal plea to legally bind an adoptee and petitioner(s) in a recognized parent-child relationship, highlighting the comprehensive nature of adult adoption proceedings in North Carolina.

Preview - Dss 5163 Form

STATE OF NORTH CAROLINA

COUNTY

(Full name of petitioning parent 1)

(Full name of petitioning parent 2)

FOR THE ADOPTION OF

(Full name by which adult adoptee is to be known if adoption granted)

IN THE GENERAL COURT OF JUSTICE

DISTRICT COURT DIVISION BEFORE THE CLERK

SP

PETITION FOR

ADULT ADOPTION

To the Honorable, Clerk of the Superior Court of

 

 

____________________County:

We (1), the undersigned,

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Name of petitioning parent 1)

 

 

 

 

(Sex)

(Marital Status)

and/or

 

 

 

 

 

 

 

 

 

whose address is

 

(Name of petitioning parent 2)

(Sex)

 

(Marital Status)

 

 

 

 

I

(Street & Number)

(RFD)

(City)

(County)

(State)

do hereby petition the Court for leave to adopt

(Name by which the adoptee is to be known)

, an adult, pursuant to N.C.G.S. 48-5-100, et. seq., and represent to the Court:

(Sex)

I

1.That the petitioner(s) herein seeking adoption has/have lived in or been domiciled in North Carolina for at

least six consecutive months immediately preceding the filing of this petition; or the adoptee has lived in North Carolina for at least six consecutive months immediately preceding the filing of this petition or from birth.

2.

That

 

was born in the State/Country of

(Original Name of Adult Adoptee)

on the

 

day of

I

3.That the petitioner(s) is/are [related] [not related] to the said adult adoptee in the following manner:

_________________________________________________________________________________________

4.That the following are the name, age, and last known address of any adult child of the prospective adoptive parent, including an adult previously adopted by the prospective adoptive parent or the adoptive parent's spouse, and the date and place of the adoption:

_________________________________________________________________________________________

5.That the following are the name, age, and last known address of any living parent, spouse, or adult child of adoptee:

_________________________________________________________________________________________

DSS-5163 (Rev. 11/2014)

Child Welfare Services

Page 1 of 2

6.That the following is a description and estimate of the value of any property of the adoptee, if adjudicated incompetent:

_________________________________________________________________________________________

7.That the adoptee’s true name as it appears on his/her birth certificate is:

 

_________________________________________________________________________________________

8.

That the adoptee is presently married to

 

 

 

 

, having been

 

married on or about the

____day of

__________I ____________

 

 

 

 

 

 

 

 

 

 

WHEREFORE, your petitioner(s) pray(s) that the relationship of parent and child be established between petitioner(s) and said adult and that the adult adoptee's name [remain] [be changed to]

_________________________________________________________________________________________

__________________________________________________________________pursuant to G. S. 48-9-102 (g).

This the

day of

 

I

 

 

 

 

 

 

 

 

 

___________________________________Signature of Petitioner 1

 

 

 

__________________________________ Signature of Petitioner 2

 

 

 

ACKNOWLEDGMENT

, being duly sworn, deposes and says that he/she has read the foregoing Petition and that the facts set forth therein are true to his/her knowledge, except as to matters therein set forth upon information and belief,, and as to those such matters he/she believes them to be true.

__________________________________Signature of Petitioner 1

__________________________________Signature of Petitioner 2

Subscribed and sworn to before me this

 

day of

I

(S E A L)

Clerk Superior Court or Notary Public

My commission expires:

________________________________________________________________________________________________

Attorney for petitioner/s(Mailing Address)

_________________________________________________________________________________________________

(Telephone Number)

(City or Town)

NOTE: The DSS-5163 is prepared in duplicate. The original form is held in the Office of the Clerk of Superior Court. A copy is forwarded, along with originals of all other documents filed in proceeding, within ten days following the entry of the Decree of Adoption by the Clerk of Court to the Division of Social Services, State Department of Health and Human Services.

DSS-5163 (Rev. 11/2014)

Child Welfare Services

Page 2 of 2

Form Data

Fact Number Description
1 This form is used for adult adoptions in North Carolina.
2 The form is governed by North Carolina General Statutes (N.C.G.S.) 48-5-100, et. seq.
3 It must be filed in the county where the petitioner or the adoptee resides.
4 Petitioners or adoptees need to have lived or been domiciled in North Carolina for at least six consecutive months before filing this petition.
5 Relationships, if any, between the petitioner(s) and the adult adoptee must be disclosed.
6 Information about any living parent, spouse, or adult child of the adoptee is required.
7 The form is revised as of November 2014 and is managed by the Child Welfare Services, under the Division of Social Services, State Department of Health and Human Services.

Instructions on Utilizing Dss 5163

Filling out the DSS-5163 form is a crucial step in the process of adult adoption in North Carolina. This form embodies your formal request to the court to establish a parent-child relationship between the petitioner(s) and an adult. By accurately completing this form, you affirm your commitment to the adoption process and facilitate a smoother court review. Here are the step-by-step instructions to guide you through filling out the form to ensure all relevant details are accurately captured.

  1. Start with entering the county name of the Superior Court where the adoption will be filed.
  2. Fill in the full name of petitioning parent 1 and, if applicable, the full name of petitioning parent 2.
  3. Write the full name by which the adult adoptee is to be known if the adoption is granted.
  4. Specify the sex and marital status of each petitioning parent, followed by their detailed address (street & number, RFD, city, county, state).
  5. State the name the adoptee will be known by post-adoption and indicate the adoptee's sex.
  6. Confirm and document that either the petitioner(s) or the adoptee have lived in or been domiciled in North Carolina for at least six consecutive months immediately preceding the filing of this petition.
  7. Enter the birth state/country of the adoptee, and specify their date of birth.
  8. Describe how the petitioner(s) is/are related (or not related) to the adoptee.
  9. List the names, ages, and last known addresses of any adult children of the prospective adoptive parent(s), including details of any previous adoptions.
  10. Provide the names, ages, and last known addresses of any living parent, spouse, or adult child of the adoptee.
  11. Include a description and estimate of the value of any property belonging to the adoptee, if applicable.
  12. State the adoptee’s true name as it appears on their birth certificate.
  13. Detail the marital status of the adoptee, including the name of the spouse and the date of marriage, if applicable.
  14. Indicate whether the adult adoptee's name will remain the same or be changed, and if so, to what.
  15. Each petitioning parent must sign and date the form.
  16. Complete the ACKNOWLEDGMENT section, affirming the truthfulness of the information provided in the petition. This includes the signature of each petitioner.
  17. The form must be notarized: Sign it in front of a notary public or the clerk of the Superior Court, who will also sign and seal the form. Fill in the notary public's commission expiration date.
  18. Include the contact information for the attorney representing the petitioner(s), if any.

After filling out the DSS-5163 form, remember to prepare it in duplicate. The original form will be filed with the Clerk of Superior Court, and a copy will be forwarded to the Division of Social Services. This administrative step is crucial for officially documenting the petition for adult adoption, marking the beginning of a legal process designed to formally recognize and establish the sought-after familial relationship. Ensure the accuracy and completeness of every detail provided to support a smooth and straightforward review by the court.

Obtain Answers on Dss 5163

  1. What is the DSS 5163 form used for in North Carolina?

    The DSS 5163 form is utilized for the process of adult adoption in North Carolina. It is a legal document submitted to the Superior Court, through which petitioners express their intention to adopt an adult, establishing a legal relationship of parent and child upon approval. This form outlines crucial information regarding the petitioner(s) and adoptee, including their residency, relationship, and any relevant financial details pertaining to the adoptee, if necessary.

  2. Who needs to fill out the DSS 5163 form?

    Any individual(s) seeking to adopt an adult in North Carolina must complete the DSS 5163 form. This includes providing detailed personal information about themselves and the adoptee, such as names, addresses, relationship to the adoptee, and the adoptee's property value if adjudged incompetent. It is crucial for the petitioner(s) to have resided in North Carolina for a minimum of six months or that the adoptee has lived in North Carolina for the same minimum duration or from birth.

  3. What are the requirements for filing a DSS 5163 form?

    To file a DSS 5163 form, the petitioner(s) must ensure several requirements are met, including a residency requirement of at least six consecutive months in North Carolina for either the petitioner(s) or the adoptee. The petition must clearly state the relation to the adoptee, disclose information about the adoptee’s and petitioner(s)’ immediate family members, provide an estimate of the adoptee's property value if adjudicated incompetent, and specify the desired legal name for the adoptee post-adoption. Proper acknowledgment in front of a Clerk of Superior Court or Notary Public, including the signatures of the petitioner(s), is also required.

  4. Can the adoptee's name be changed through this adoption process?

    Yes, the adoption process outlined in the DSS 5163 form allows for the change of the adoptee's name. The petition includes a section where the petitioner(s) can specify the new name by which the adult adoptee will be known, contingent upon the court's approval of the adoption. The change of name is part of establishing the new parent-child relationship.

  5. What information about the adoptee’s family is required on the form?

    The form requires detailed information about the adult adoptee's immediate family, including any living parent, spouse, or adult child. This includes their names, ages, and last known addresses. Similar information regarding any adult child of the prospective adoptive parent(s) is also requested, whether biologically related or previously adopted. This information helps the court in evaluating the petition and ensuring all relevant parties are considered.

  6. What does acknowledgment before a Clerk or Notary Public entail?

    Acknowledgment before a Clerk of Superior Court or a Notary Public involves the petitioner(s) swearing or affirming that the information provided in the form is accurate to the best of their knowledge. This step, which includes the signature of the petitioner(s) and the official stamp or seal of the Clerk or Notary Public, is vital for confirming the authenticity of the petition and the veracity of the information presented.

  7. What happens after the DSS 5163 form is filed?

    After the DSS 5163 form is filed, it will be reviewed by the clerk of the Superior Court. The adoption process may involve legal proceedings to assess the suitability and preparedness of the petitioner(s) to adopt the adult. Upon approval, a Decree of Adoption is issued, legally establishing the relationship between the petitioner(s) and the adoptee. Subsequently, a copy of this form, along with all related documents filed during the proceeding, is forwarded to the Division of Social Services, State Department of Health and Human Services, within ten days following the entry of the Decree of Adoption.

Common mistakes

Filling out the DSS-5163 form, a critical document for the adult adoption process in North Carolina, requires close attention to detail. Unfortunately, mistakes can happen. Recognizing and avoiding these errors can greatly expedite the adoption process and reduce setbacks. Here are ten common mistakes people make when completing this form:

  1. Not verifying residency requirements: Both the petitioner(s) and the adoptee must meet specific residency requirements for the adoption to proceed. Failing to accurately document this can result in the rejection of the petition.

  2. Incorrectly stating the relationship to the adoptee: The form requires a clear description of the petitioner's current relationship to the adult being adopted, whether related by blood or not. Misrepresenting this relationship can cause complications.

  3. Omitting details of the adult adoptee's biological family: All known living parents, spouses, or adult children of the adoptee must be mentioned, with their latest contact information. Neglecting to include any one of them can delay the process.

  4. Forgetting to list any adult child (including previously adopted) of the prospective adoptive parent(s): This information is crucial for a complete understanding of the family composition post-adoption.

  5. Failing to disclose the adoptee's property and its value if adjudicated incompetent: This could be considered as withholding critical information, affecting the petition’s outcome.

  6. Incorrectly reporting the adoptee’s true name as per birth certificate: Accurate names are essential for legal documents to ensure consistency across records.

  7. Not specifying the marital status of the adoptee correctly, including the name of the spouse and the date of marriage: This information is required for a holistic assessment of the adoptee's current life situation.

  8. Miscategorizing the adoptee's birth details: Location and date of birth must match official documents exactly to avoid questions of identity verification.

  9. Signature discrepancies: All parties involved must sign the form, and these signatures must match other legal documents. Any discrepancy here could suggest potential fraud.

  10. Inconsistencies in the request for the adoption and name change: Clear, unambiguous wording about the desired outcome post-adoption, especially concerning the adoptee’s name change, is crucial.

Avoiding these common pitfalls ensures a smoother process for all involved, demonstrating diligence and respect for the legal framework governing adult adoptions in North Carolina.

Documents used along the form

When filing a DSS-5163 form in the State of North Carolina for the adult adoption process, several other forms and documents are often required to support the petition. These documents serve to provide additional information, ensuring that the process adheres to legal standards and protects the interests of all parties involved. A thorough understanding of these documents can help streamline the adoption process.

  • Consent Form: This form is completed by the adult being adopted, indicating their consent to the adoption process. It's a crucial document that legally signifies agreement.
  • Background Check Forms: These are completed by the adopting parents. Background checks are mandatory to ensure the safety and well-being of the adoptee.
  • Medical History Forms: These provide a comprehensive medical history of the adoptee, offering crucial health information to the adoptive parents.
  • Financial Statement: This document outlines the financial capability of the adoptive parents, ensuring that they have the means to provide for the adoptee.
  • Home Study Documentation: For some adoptions, a home study may be required, detailing the living environment into which the adoptee will be placed.
  • Birth Certificate of Adoptee: A copy of the adoptee’s original birth certificate must be submitted with the petition to substantiate the adoptee's identity and age.
  • Marriage Certificate of Adopting Parents (if applicable): If the adopting parents are married, a copy of their marriage certificate might be required to confirm the marital status.
  • Legal Representation Documentation: Any documents pertaining to the legal representation of either the adoptive parents or the adoptee should be included. This often comprises a retainer agreement or a letter of representation.

Collectively, these documents complement the DSS-5163 form, each playing a unique role in the adult adoption process. Proper preparation and submission of these forms and documents can facilitate a smoother and more efficient adoption procedure, ultimately ensuring that the legal requirements are met and the best interests of all involved parties are upheld.

Similar forms

  • Petition for Child Adoption: Similar to the DSS-5163 form, a Petition for Child Adoption seeks to establish a legal parent-child relationship but focuses on minors rather than adults. Both documents detail the petitioner's relationship to the adoptee, the adoptee’s personal information, and the juridical process required to establish the adoption formally.

  • Application for Name Change: This document, like the DSS-5163, may include a section on changing the adoptee's name post-adoption. Both require detailed personal information and sworn statements before a notary public or judicial officer to ensure the accuracy and truthfulness of the information provided.

  • Guardianship Petition: Similar to an adoption petition, a Guardianship Petition is filed to establish a legal guardianship over an individual, often a minor or an adult unable to make decisions due to disability. Both documents necessitate the presentation of the guardian’s or adoptive parent’s suitability and the relationship to the ward or adoptee.

  • Temporary Custody Agreement: This document, while typically more temporary and possibly less formal than the DSS-5163 form, also outlines the custodial arrangement between a legal guardian and another party. Both documents clarify the custodial rights and responsibilities towards the minor or adult in their care.

  • Marriage License Application: While serving different purposes, a Marriage License Application shares with the DSS-5163 form the necessity of detailed personal information, declarations of existing legal relationships, and sometimes, a change of name post-marriage, mirroring the potential name change in adoption.

  • Power of Attorney: A document appointing another party to make decisions on one’s behalf shares the importance of a formal, legal declaration of a relationship between two parties with the DSS-5163. Both entail significant responsibility over another’s affairs, although in vastly different contexts.

  • Consent to Adoption Form: A critical component of the adoption process, this form, signed by the biological parents or guardians relinquishing their parental rights, complements the DSS-5163 by facilitating the adoption process through legal consent, underscoring the importance of authorized agreement in adoption proceedings.

  • Birth Certificate Application: The quest for a new or amended birth certificate often follows the adoption process, requiring detailed information similar to the DSS-5163 form. Both are crucial in legally recognizing the adoptee’s identity and relationship with the adoptive parents.

  • Divorce Decree: Although concerning the dissolution of a marriage rather than the formation of a parent-child bond, a Divorce Decree shares with the DSS-5163 form the legal recognition of a changed family structure. Both documents involve legal proceedings that significantly alter individuals' status and relationships.

  • Immigrant Petition for Relative: This form establishes a legal basis for family members seeking to immigrate, bearing similarity to the DSS-5163’s objective of legally establishing a familial relationship. Both require the demonstration of a legitimate relationship and involve legal proceedings to recognize this relationship formally.

Dos and Don'ts

When filling out the DSS-5163 form for an adult adoption in North Carolina, it's important to approach the task carefully and thoughtfully. Here are some do's and don'ts to help guide you through the process:

  • Do ensure you meet the residency requirements. At least one party, either the petitioner(s) or the adoptee, must have lived in North Carolina for six consecutive months before filing.
  • Do provide accurate and truthful information regarding your relationship to the adoptee, their property (if applicable), and details of any living parents, spouses, or adult children.
  • Do list the adoptee's true name as it appears on their birth certificate, ensuring accuracy in identification.
  • Do carefully review your petition before submitting it, verifying that all information is complete and accurate to the best of your knowledge.
  • Do sign the petition in the presence of a notary public or clerk, as your signature needs to be acknowledged officially.
  • Don't overlook detailing your relationship to the adoptee or misstate the nature of this relationship—it's vital for the court's understanding of your petition.
  • Don't forget to include any relevant information about the adoptee's marriage, if applicable, as this can affect the legal process.
  • Don't hesitate to seek legal advice if you're unsure about any part of the form. An attorney can provide valuable guidance to ensure your petition is filled out correctly.

Remember, the adult adoption process is a significant legal proceeding that establishes a permanent parent-child relationship. Taking the time to thoroughly and accurately complete the DSS-5163 form is a crucial step in this journey.

Misconceptions

There are several misconceptions regarding the DSS-5163 form, used for adult adoption petitions in North Carolina. Understanding these misunderstandings is vital for a smooth legal process. Here's a look at four common myths:

  • Only minors can be adopted. A common misconception is that adoption processes are exclusively for children under the age of 18. However, the DSS-5163 form is specifically designed for the adoption of adults, demonstrating the legal provision for adult adoptions in North Carolina.
  • The process does not require legal representation. While it might seem straightforward to fill out the form and submit it to the court, the process involves intricate legal considerations. For instance, understanding the implications of changing the adult adoptee’s name and ensuring all consent requirements are met can be complex. Therefore, seeking legal advice or representation is often necessary to navigate the process effectively.
  • All adult adoptions are related to inheritance purposes. While many adult adoptions occur to formalize an existing parent-child relationship for inheritance reasons, this is not the sole purpose. Adult adoptions can also be carried out to legalize a step-parent relationship, solidify an emotional bond, or for a variety of other personal reasons that do not necessarily involve financial considerations.
  • Adult adoptions are finalized immediately after submitting the DSS-5163 form. The filing of the DSS-5163 form is a critical step, but it initiates a legal process rather than concluding it. This process includes court hearings, and, in some cases, obtaining consents from relevant parties. The court needs to approve the petition for the adoption to be legally finalized.

Understanding these key aspects of the DSS-5163 form and the adult adoption process can help petitioners navigate the journey with clearer expectations and ensure they adhere to North Carolina’s legal requirements.

Key takeaways

Filling out and using the DSS 5163 form correctly is essential for the smooth processing of adult adoption requests in North Carolina. This form is integral to petitioning the court for the adoption of an adult, establishing a new legal relationship recognized by the state. Here are key takeaways to remember:

  • Residency requirements: At least one party—either the petitioner(s) or the adoptee—must have lived in or been domiciled in North Carolina for at least six consecutive months immediately before filing this petition.
  • Proving relationships: The petition must clearly state whether the petitioners are related to the adoptee and, if so, describe the nature of the relationship.
  • Full disclosure: Information about any of the adoptee's or petitioner's living parents, spouses, adult children, or any adult previously adopted by the petitioner or the petitioner's spouse must be fully disclosed.
  • Property and competence: If the adoptee has been adjudicated incompetent, a description and estimate of the adoptee's property value must be provided.
  • Marital status: The form requires the current marital status of the adoptee, including the name of the spouse and the date of marriage if applicable.
  • Intention for adoptee's name: The petitioners must state whether they wish for the adoptee's name to remain the same or be changed, providing the new name if a change is desired.
  • Importance of accuracy: All information provided must be accurate to the best of the petitioner's knowledge, and false statements might have legal consequences. Petitioners must affirm the truthfulness of their statements under oath.
  • Legal representation: While not mandatory, having an attorney can help navigate the legal complexities of the adoption process, ensuring that all procedural requirements are met.
  • Submission and notification: The original DSS 5163 form must be filed with the Clerk of Superior Court's Office, and a copy, along with all other documents related to the adoption proceeding, must be sent to the Division of Social Services within ten days following the entry of the Decree of Adoption.

Understanding these key points ensures that petitioners are well-informed and prepared for a successful adult adoption process in North Carolina.

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