Family Law Petition for Adoption

IN THE IOWA DISTRICT COURT FOR POLK COUNTY


IN THE MATTER OF
THE ADOPTION OF: CASE NO. ATAT010101

Jane Lynn Doe,

A Minor Child, PETITION FOR ADOPTION

By: Justin and Sydney Brown,
Petitioners.


COMES NOW Petitioners, through counsel, and in support of this petition for adoption,

state as follows:

1. The person to be adopted in this matter is Jane Lynn Doe (hereinafter “minor child”),

who resides and is domiciled in Des Moines, Polk County, Iowa.

2. The minor child was born on July 10, 2017, in Des Moines, Polk County, Iowa. See Exh.

A, Birth Certificate.

3. It is requested that the minor child’s name be changed to Jane Lynn Brown through this

adoption.

4. The minor child’s current guardians and custodians are the petitioners, Justin and Sydney

Brown. She has lived with them since birth. The petitioners reside and are domiciled in

Des Moines, Polk County, Iowa.

5. The minor child’s biological father is Joseph Doe, who resides and is domiciled in Des

Moines, Polk County, Iowa.

6. The minor child’s biological mother is Kelly Doe, who resides and is domiciled in Des

Moines, Polk County, Iowa.




1