Judicial Council of California, courts.ca.gov

c82700961457a5ecd25fd6513b5b8da01267898d

California Superior Local Rules

Lawyer (if any): (Name, address, telephone number, and State Bar number): Check this box if there are more adopting parents. Use a separate piece of paper and write “ADOPT-230, Other Adopting Parents” at the top and complete a–d. Turn it in with this form. 2 Name of child after adoption: 3 List services you received that were related to the adoption of the child listed in 2 .

Include all medical, hospital, attorney, legal fees and costs, doctors and physicians, surgeons, licensed adoption agency, or any other person or organization that received payment in connection with the birth of the child, expenses, and services received by either birth parent or by the child. (Examples of other services provided: prenatal care, transportation, counseling, adoption service provider, pregnancy expenses, court filing fees, fingerprinting fees.) Service Name and address of service provider How much paid, or value of service Payment date a. $ b. $ c. $ d. $ For your protection and privacy, please press the Clear This Form button after you have printed the form.

Rev. July 1, 2025 Adoption Expenses ADOPT-230, Adopting parent or parents: Case Number: Service Name and address of service provider How much paid, or value of service Payment date e. $ f. $ g. $ h. $ i. $ j. $ k. $ l. $ Number of pages attached: Check this box if you need more space to list the services related to this adoption. Use a separate piece of paper and write “ADOPT-230, Item 3—Payment for Services” at the top and include the service, name and address of provider, amount paid, and payment date.

Turn it in with this form. 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 Date: Type or print your name Signature of adopting parent

Document details

Collection	California Superior Local Rules
Citation	c82700961457a5ecd25fd6513b5b8da01267898d
Type	court_rule
Language	en
Format	pdf
Source	CA_LOCAL
Identifier	c82700961457a5ecd25fd6513b5b8da01267898d

Source file is stored in the law ingest library (pdf).