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The DSS 5163 form plays a crucial role in the adult adoption process in North Carolina, providing a structured means for individuals to formalize their desire to adopt an adult. This legal document is submitted to the Clerk of the Superior Court and requires detailed information about the petitioning parents and the adult adoptee. Key components of the form include the names and addresses of the petitioners, their relationship to the adoptee, and the adoptee's original name as it appears on their birth certificate. Additionally, the form mandates the disclosure of any adult children of the petitioners and living relatives of the adoptee, ensuring that all relevant parties are considered in the adoption process. It also requests a description of the adoptee's property if they are adjudicated incompetent. By signing the form, petitioners affirm that the information provided is accurate to the best of their knowledge, which is essential for maintaining the integrity of the legal proceedings. The completed form is submitted in duplicate, with one copy retained by the Clerk and another forwarded to the Division of Social Services after the adoption decree is granted. This process not only facilitates the legal recognition of the parent-child relationship but also underscores the importance of transparency and accountability in family law matters.

Form Sample

DSS-5163 (Rev. 11/2014)
Child Welfare Services
Page 1 of 2
STATE OF NORTH CAROLINA IN THE GENERAL COURT OF JUSTICE
DISTRICT COURT DIVISION
COUNTY BEFORE THE CLERK
SP
(Full name of petitioning parent 1)
(Full name of petitioning parent 2)
PETITION FOR
FOR THE ADOPTION OF
(Full name by which adult adoptee is to be known if adoption granted)
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
I
(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)
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 2 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.

Document Specifications

Fact Name Details
Form Purpose The DSS 5163 form is used for adult adoption petitions in North Carolina.
Governing Law This form is governed by N.C.G.S. 48-5-100, et. seq.
Petitioner Requirements Petitioners must have lived in North Carolina for at least six consecutive months.
Adoptee Information The form requires the adoptee's true name as it appears on their birth certificate.
Property Disclosure Petitioners must provide a description and estimate of the adoptee's property if adjudicated incompetent.
Child Information Details about any adult children of the prospective adoptive parent must be included.
Marriage Status The form asks if the adoptee is currently married, including the date of marriage.
Signature Requirement Both petitioners must sign the form, affirming the truth of the information provided.
Submission Process The original form is filed with the Clerk of Superior Court; copies are sent to the Division of Social Services.

Steps to Filling Out Dss 5163

Filling out the DSS 5163 form is an important step in the adult adoption process in North Carolina. Ensure that all information is accurate and complete before submitting the form to the court. Following these steps will help you navigate the form efficiently.

  1. Begin by entering the county where you are filing the petition.
  2. In the section for petitioning parents, provide the full names of both petitioning parents.
  3. Indicate the sex and marital status of each parent.
  4. Fill in the address of each petitioning parent, including street number, city, county, and state.
  5. State the full name of the adult adoptee as they will be known if the adoption is granted.
  6. Confirm that the petitioner(s) have lived in North Carolina for at least six consecutive months prior to filing, or that the adoptee has lived in North Carolina for the same duration.
  7. Provide the original name of the adult adoptee and their date of birth.
  8. Indicate the relationship between the petitioner(s) and the adult adoptee, specifying if they are related or not related.
  9. List the name, age, and last known address of any adult child of the prospective adoptive parent.
  10. Provide the name, age, and last known address of any living parent, spouse, or adult child of the adoptee.
  11. If applicable, describe any property of the adoptee if they have been adjudicated incompetent, including an estimate of its value.
  12. State the adoptee’s true name as it appears on their birth certificate.
  13. Provide the name of the adoptee’s current spouse, along with the date of their marriage.
  14. Indicate whether the adoptee’s name will remain the same or be changed.
  15. Sign and date the form at the bottom, ensuring both petitioners provide their signatures.
  16. Complete the acknowledgment section, where each petitioner swears that the information provided is true.
  17. Have the form signed by a notary public or the Clerk of Superior Court, if required.

Once the form is completed, it must be filed with the Clerk of Superior Court. The original will be kept on file, while a copy should be sent to the Division of Social Services within ten days of the adoption decree. Ensure all supporting documents are included with the filing.

More About Dss 5163

What is the DSS 5163 form used for?

The DSS 5163 form is a petition for adult adoption in North Carolina. It is used by individuals seeking to legally adopt an adult, establishing a parent-child relationship under North Carolina law. This form must be filed in the District Court division before the Clerk of the Superior Court.

Who can file the DSS 5163 form?

Any individual or couple who meets the residency requirements in North Carolina can file the DSS 5163 form. At least one of the petitioners must have lived in North Carolina for six consecutive months before filing. Additionally, the adoptee must also meet the residency requirement, having lived in North Carolina for the same duration or from birth.

What information is required on the DSS 5163 form?

The form requires various details, including the names and addresses of the petitioners, the name of the adult adoptee, and their relationship to the adoptee. It also asks for information about the adoptee's parents, spouse, and any adult children, as well as a description of the adoptee's property if they are adjudicated incompetent.

Can the name of the adult adoptee be changed?

Yes, the petitioners can request that the name of the adult adoptee be changed as part of the adoption process. This request must be clearly stated in the petition, and the court will consider it when granting the adoption.

Is there a fee associated with filing the DSS 5163 form?

Yes, there is typically a filing fee associated with submitting the DSS 5163 form. The exact amount may vary by county, so it's advisable to check with the local Clerk of Superior Court for the current fee schedule.

What happens after the DSS 5163 form is filed?

After filing, the Clerk of the Superior Court will review the petition. If everything is in order, a hearing may be scheduled. The court will then decide whether to grant the adoption based on the information provided in the petition and any other relevant factors.

Do both petitioners need to sign the DSS 5163 form?

Yes, both petitioners must sign the form. This indicates that both parties are in agreement with the adoption process and the information contained in the petition. Their signatures also confirm that they have read and understood the petition.

What if the adult adoptee is married?

If the adult adoptee is married, the petition must include the name of the spouse and the date of marriage. This information is important for the court to consider the legal implications of the adoption on the adoptee's marital status.

How is the DSS 5163 form submitted?

The DSS 5163 form must be submitted in person at the Clerk of the Superior Court's office in the appropriate county. It should be prepared in duplicate, with the original form being kept on file and a copy sent to the Division of Social Services after the adoption decree is entered.

What is the role of the Clerk of the Superior Court in this process?

The Clerk of the Superior Court oversees the filing of the DSS 5163 form and manages the adoption proceedings. They ensure that all necessary documents are filed correctly and may schedule hearings. The Clerk also maintains the official records of the adoption once it is granted.

Common mistakes

  1. Incomplete Information: Many individuals fail to provide all required information, such as the full names of both petitioning parents or the adult adoptee. Omissions can lead to delays in processing the petition.

  2. Incorrect Dates: Mistakes often occur with dates, particularly the birth date of the adoptee or the date of marriage. An incorrect date can create confusion and may require additional documentation.

  3. Improper Signatures: Both petitioners must sign the form. A common error is having only one signature, which can invalidate the petition.

  4. Failure to Notarize: Some applicants neglect to have the form notarized. This step is crucial for the document's validity and must not be overlooked.

  5. Missing Address Information: Providing an incomplete address for the petitioners or the adoptee can lead to complications. Ensure that all address fields are filled out completely.

  6. Ignoring Relationship Details: The form requires specific information about the relationship between the petitioners and the adoptee. Failing to clarify this relationship can result in rejection of the petition.

  7. Not Meeting Residency Requirements: Applicants must confirm that they or the adoptee have lived in North Carolina for at least six months. Not adhering to this requirement can disqualify the petition.

Documents used along the form

When filing the DSS 5163 form for adult adoption, several other documents may also be required to support the process. Below is a list of commonly used forms and documents that accompany the DSS 5163.

  • Adoption Consent Form: This document is used to obtain consent from the adoptee and any other necessary parties, such as biological parents, if applicable. It ensures that all involved individuals agree to the adoption.
  • Background Check Authorization: This form allows the court to conduct background checks on the petitioners. It is a standard procedure to ensure the safety and well-being of the adoptee.
  • Financial Disclosure Statement: This document provides information about the financial status of the petitioners. It is used to assess the ability of the adoptive parents to support the adoptee.
  • Home Study Report: A home study is typically required to evaluate the living conditions of the petitioners. This report is prepared by a social worker and assesses the suitability of the home for the adoptee.
  • Final Adoption Decree: Once the adoption is approved, this legal document finalizes the adoption process. It outlines the new legal relationship between the adoptive parents and the adoptee.

These documents play a crucial role in the adult adoption process, ensuring that all legal requirements are met and that the best interests of the adoptee are prioritized. Having these forms prepared and submitted alongside the DSS 5163 can help facilitate a smoother adoption experience.

Similar forms

The DSS 5163 form is similar to the Adoption Application form used in many states. This document serves as a formal request for adoption and outlines the details of the prospective adoptive parents and the child. Like the DSS 5163, it requires information about the relationship between the adoptive parents and the child, as well as a declaration of residency. Both forms aim to establish a legal basis for adoption and ensure that all parties involved meet the necessary criteria.

Another document that shares similarities with the DSS 5163 is the Petition for Guardianship. This form is used when an individual seeks legal guardianship over another person, typically a minor. Both documents require detailed personal information about the parties involved and the relationship between them. They also involve a court process to formalize the arrangement, ensuring that the best interests of the individual in question are upheld.

The Termination of Parental Rights form is also comparable to the DSS 5163. This form is utilized when a parent voluntarily or involuntarily relinquishes their rights to a child. Both forms involve legal proceedings and require documentation of the parent-child relationship. The goal of each form is to clarify the legal standing of the individuals involved, paving the way for adoption or guardianship.

The Name Change Petition is another document that bears resemblance to the DSS 5163. This form is filed when an individual wishes to change their name legally. Like the DSS 5163, it includes personal information and requires a court's approval. Both forms seek to modify an individual's legal identity, whether through adoption or name change, and must be processed through the court system.

The Child Custody Agreement is similar in that it outlines the legal rights and responsibilities of parents regarding their children. This document often comes into play during divorce or separation proceedings. Both the Child Custody Agreement and the DSS 5163 require detailed information about the parties involved and aim to establish a legal framework for the care and upbringing of a child or adult adoptee.

The Foster Care Placement Agreement also shares similarities with the DSS 5163. This form is used when a child is placed in foster care and outlines the responsibilities of the foster parents. Both documents require information about the individuals involved and seek to establish a legal relationship between the caregiver and the child. They aim to ensure that the child's best interests are prioritized in a legal context.

The Affidavit of Support is another document that can be likened to the DSS 5163. This form is often used in immigration cases to demonstrate that a person has the financial means to support an individual coming to the U.S. Like the DSS 5163, it requires personal information and an affirmation of the relationship between the parties. Both documents serve to establish a legal obligation and ensure that the individual in question will be adequately supported.

The Power of Attorney form is similar in that it allows one person to act on behalf of another in legal matters. This document requires detailed information about both parties and specifies the powers granted. Like the DSS 5163, it must be executed with legal formalities to ensure its validity. Both forms establish a legal relationship and clarify the rights and responsibilities of the individuals involved.

The Will is another document that shares some common ground with the DSS 5163. While a Will outlines the distribution of a person's assets after death, it also addresses the care of minor children. Both documents require detailed personal information and aim to provide legal clarity regarding familial relationships. They serve to protect the interests of individuals involved in significant life changes.

Lastly, the Divorce Decree can be compared to the DSS 5163. This document finalizes the legal dissolution of a marriage and often includes provisions for child custody and support. Both forms require extensive information about the parties involved and their relationship to one another. They aim to establish a legal framework for the future, ensuring that all parties understand their rights and responsibilities moving forward.

Dos and Don'ts

Filling out the DSS 5163 form for adult adoption can be a straightforward process if you follow some essential guidelines. Here’s a list of things to do and avoid to ensure your application is completed correctly.

  • Do ensure all names are spelled correctly, including the names of both petitioners and the adoptee.
  • Do provide accurate information regarding residency. Confirm that the petitioners or the adoptee have lived in North Carolina for at least six consecutive months.
  • Do include the adoptee's true name as it appears on their birth certificate. This is crucial for the legal process.
  • Do list any living parents or adult children of the adoptee, along with their last known addresses.
  • Do sign the petition in front of a notary public to ensure it is legally valid.
  • Don't leave any sections blank. Every part of the form must be completed to avoid delays.
  • Don't forget to check for consistency in the information provided. Mismatched details can lead to complications.
  • Don't submit the form without making a copy for your records. Keeping a copy is essential for future reference.
  • Don't overlook the acknowledgment section. Both petitioners must affirm the truth of the information provided.

By adhering to these guidelines, you can navigate the process of completing the DSS 5163 form more effectively, ensuring a smoother path toward the adoption process.

Misconceptions

Understanding the DSS 5163 form can be challenging, and several misconceptions often arise. Here are five common misunderstandings about this important document:

  • Misconception 1: The DSS 5163 form is only for adopting children.
  • Many people believe this form is exclusively for the adoption of minors. In reality, the DSS 5163 is specifically designed for the adoption of adults. This allows individuals to formalize their relationship with an adult they wish to adopt.

  • Misconception 2: You must be related to the adoptee to use this form.
  • Some think that a familial relationship is necessary for adult adoption. However, the form accommodates both related and non-related individuals, making it accessible for various personal situations.

  • Misconception 3: The adoption process is the same for adults and children.
  • While the overall goal of establishing a legal parent-child relationship remains the same, the procedures and requirements can differ significantly between adult and child adoptions. Adult adoptions often involve fewer legal hurdles.

  • Misconception 4: You need a lawyer to file the DSS 5163 form.
  • Many people assume that hiring an attorney is mandatory for completing this form. In fact, individuals can file the form on their own, although legal advice can be beneficial in navigating the process.

  • Misconception 5: The adoption is finalized immediately upon filing the form.
  • Some may think that submitting the DSS 5163 form instantly grants legal parentage. In reality, the adoption process involves a review by the court and may take time before the adoption is finalized.

Key takeaways

When filling out and using the DSS 5163 form for adult adoption in North Carolina, keep these key takeaways in mind:

  • Eligibility Requirements: Ensure that either the petitioners or the adoptee have lived in North Carolina for at least six consecutive months before filing the petition.
  • Petition Details: Clearly state the names, marital status, and addresses of both petitioning parents. Provide all necessary information about the adoptee, including their original name and current marital status.
  • Relationship Disclosure: Indicate whether the petitioners are related to the adoptee and describe the nature of that relationship.
  • Property Information: If the adoptee has been adjudicated incompetent, include a description and estimate of their property value.
  • Signature Requirement: Both petitioners must sign the form, affirming that the information provided is true to the best of their knowledge.
  • Submission Process: Submit the original form to the Clerk of Superior Court. A copy must be sent to the Division of Social Services within ten days after the adoption decree is entered.