Dss 5163 PDF Details

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You can find details about the type of form you want to fill out in the table. It will tell you the span of time you will need to finish dss 5163, what parts you will have to fill in and a few other specific details.

Form NameDss 5163
Form Length2 pages
Fillable fields0
Avg. time to fill out30 sec
Other namesaddoption papers, nc adoption paper pacakage, adoption papers north carolina, adoption form pdf

Form Preview Example



(Full name of petitioning parent 1)

(Full name of petitioning parent 2)


(Full name by which adult adoptee is to be known if adoption granted)






To the Honorable, Clerk of the Superior Court of




We (1), the undersigned,















(Name of petitioning parent 1)






(Marital Status)











whose address is


(Name of petitioning parent 2)



(Marital Status)






(Street & Number)





do hereby petition the Court for leave to adopt

(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:



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.




was born in the State/Country of

(Original Name of Adult Adoptee)

on the


day of


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 1 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:




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












___________________________________Signature of Petitioner 1




__________________________________ Signature of Petitioner 2





, 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


(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.

DSS-5163 (Rev. 11/2014)

Child Welfare Services

Page 2 of 2

How to Edit Dss 5163 Online for Free

Very few tasks are easier than preparing documents through our PDF editor. There isn't much you need to do to update the adoption papers for adults document - only adopt these measures in the following order:

Step 1: You can choose the orange "Get Form Now" button at the top of this webpage.

Step 2: Now, you are on the document editing page. You may add text, edit present details, highlight certain words or phrases, insert crosses or checks, add images, sign the document, erase unnecessary fields, etc.

You should provide the next data if you would like fill in the template:

stage 1 to filling in adoption papers online

Complete the Name of petitioning parent, Sex, Marital Status, Street Number, RFD, City, County, State, do hereby petition the Court for, Name by which the adoptee is to be, an adult pursuant to NCGS et seq, Sex, That the petitioners herein, hashave lived in or been domiciled, and That areas with any information that will be asked by the software.

Entering details in adoption papers online step 2

Mention the important particulars in parent including an adult, That the following are the name, and DSS Rev Child Welfare Services part.

Filling in adoption papers online step 3

The That the following is a, That the adoptees true name as it, That the adoptee is presently, having been, married on or about the, day of, WHEREFORE your petitioners prays, pursuant to G S g, This the, day of, Signature of Petitioner, Signature of Petitioner, ACKNOWLEDGMENT, and being duly sworn deposes and says box can be used to point out the rights and responsibilities of either side.

Finishing adoption papers online stage 4

Finalize by checking the next fields and typing in the required details: being duly sworn deposes and says, Signature of Petitioner, Signature of Petitioner, Subscribed and sworn to before me, day of, S E A L, My commission expires, Clerk Superior Court or Notary, Attorney for petitioners, Mailing Address, Telephone Number, City or Town, and NOTE The DSS is prepared in.

Filling in adoption papers online stage 5

Step 3: In case you are done, click the "Done" button to export the PDF file.

Step 4: Have a copy of any document. It's going to save you some time and enable you to stay clear of difficulties down the road. By the way, your details isn't going to be distributed or viewed by us.

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