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Judgment And Decree

STATE OF MINNESOTA

DISTRICT COURT

COUNTY OF DAKOTA

FIRST JUDICIAL DISTRICT

In the Matter of the Petition of

JUDGMENT AND DECREE

_______________________________________ and

Court File No.: __________________

____________________________________ his wife

_________________________________

to adopt ___________________________________

DATE

(specify name desired by adoptive parents)

A MINOR CHILD

The above-entitled matter came regularly on for hearing before the above-named court, at Chambers, on the

________________________ day of _____________________________________, 20_____; and the court being

fully advised in the premises, did, on the ____________________ day of ________________________________,

20________, duly make and file its findings and order granting the prayer of the petitioners herein.

Now, pursuant to said order and on motion of _______________________________________________,

Attorney for Petitioners, it is hereby adjudged and decreed that from and after the date hereof, the said child, having

been given the name ________________________________________________________________ by petitioners,

and File No. _____________________________ by the Commissioner of Human Services of the State of Minnesota,

shall be deemed and taken to be the child and heir of the petitioners above named in all respects the same as though

born to them in lawful wedlock.

It is further adjudged and decreed that the name of said child be, and the same is hereby legally changed to and

established as ___________________________________________________________.

BY THE COURT:

CAROLYN M. RENN, COURT ADMINISTRATOR

By______________________________________________

Court Specialist

Judgment And Decree