ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address): FOR COURT USE ONLY
TELEPHONE NO.: FAX NO. (Optional):
E-MAIL ADDRESS (Optional):
ATTORNEY FOR (Name):
SUPERIOR COURT OF CALIFORNIA, COUNTY OF IMPERIAL
939 W. MAIN STREET
EL CENTRO, CA 92243
IN THE MATTER OF:
PETITIONER.
ADOPTION CITATION TO DECLARE MINOR FREE FROM CASE NUMBER:
PARENTAL CUSTODY AND CONTROL OF PARENT FOR
STEPPARENT ADOPTION
To (name): _________________________________________________________
(Parents Whose Rights May Be Terminated)
By order of the Court, you are hereby advised that you are requested to appear before the
judge presiding in Department _____ of this Court on ___________ (Date) at 8:30 a.m. to show
cause, if any you have, why ___________________ (Child’s Name), a minor, should not be
declared free from custody and control of his/her parent__________________.
MARIA RHINEHART,
INTERIM CLERK OF THE COURT
Dated: by ,
Deputy Clerk
DO NOT use for conservatorships or for guardianships of adults.
Form Approved for Optional Use ADOPTION CITATION TO DECLARE MINOR imperial.courts.ca.gov
AD-04 (Adopted 01/01/12, FREE FROM PARENTAL CUSTODY AND CONTROL
Revised 01/01/13, 01/01/15) OF PARENT FOR STEPPARENT ADOPTION