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Probate

MAINE JUDICI AL BRANCH ADA Notice: The Maine Judicial Branch complies with the Americans with Disabilities Act (ADA). If you need a reasonable accommodation contact the Court Access Coordinator, accessibility@courts.maine.gov, or a court clerk. Language Services: For language assistance and interpreters, contact a court clerk or interpreters@courts.maine.gov. Page 1 of 3 www.courts.maine.gov FM-002, Rev. 07/20 Family and Probate Matter Summary Sheet FAMILY AND PROBATE MATTER SUMMARY SHEET This form is used for entering basic information about the case and the parties into court records. You must complete and file this form with the Clerk when you file your Complaint or Motion. PLEASE NOTE: You are not required to give a copy of this form to the other party. COURT LOCATION (where you are filing this action): TYPE OF ACTION (select one): Divorce – real estate involved Divorce – no real estate Parental Rights & Responsibilities (unmarried parents) Parentage (determining parents of a child) Judicial Separation Annulment Adoption of a minor Guardianship of a minor Name change of a minor Registration of foreign judgment or order Other family matter TYPE OF FILING (select one): Original proceeding Case transferred from probate court. Original docket number: Post-Judgment Motion: Original docket number: to Modify to Enforce for Contempt to Terminate Parental Rights Other: Plaintiff/Petitioner Information: (Person starting the action or if post-judgment, name of person who was the plaintiff or petitioner in the original case.) Name: First Middle Last Maiden Mailing Address: City State Zip Physical Address: City State Zip Gender: Date of Birth (mm/dd/yyyy): SS Number Disclosure Required on separate form Home Telephone: Work Telephone: Email: Attorney’s Name: Bar ID#: Plaintiff/Petitioner I nformation: (A second plaintiff or petitioner, or person starting the case, if applicable.) Name: First Middle Last Maiden Mailing Address: City State Zip Physical Address: City State Zip Gender: Date of Birth (mm/dd/yyyy): SS Number Disclosure Required on separate form CONTAINS NONPUBLIC DIGITAL INFORMATION MAINE JUDICIAL BRANCH ADA Notice: The Maine Judicial Branch complies with the Americans with Disabilities Act (ADA). If you need a reasonable accommodation contact the Court Access Coordinator, accessibility@courts.maine.gov, or a court clerk. Language Services: For language assistance and interpreters, contact a court clerk or interpreters@courts.maine.gov. FM-002, Rev. 07/20 Page 2 of 3 www.courts.maine.gov Family Matter Summary Sheet Home Telephone: Work Telephone: Email: Attorney’s Name: Bar ID#: Defendant/Respondent Information: (Person being served or if post-judgment, name of person who was the defendant or respondent in the original case.) Name: First Middle Last Maiden Mailing Address: City State Zip Physical Address: City State Zip Gender: Date of Birth (mm/dd/yyyy): SS Number Disclosure Required on separate form Home Telephone: Work Telephone: Email: Attorney’s Name: Bar ID#: Defendant/Respondent Information: (A second defendant or respondent, or person being served, if applicable.) Name: First Middle Last Maiden Mailing Address: City State Zip Physical Address: City State Zip Gender: Date of Birth (mm/dd/yyyy): SS Number Disclosure Required on separate form Home Telephone: Work Telephone: Email: Attorney’s Name: Bar ID#: Other Party Information: (if applicable): Name: First Middle Last Maiden Mailing Address: City State Zip Physical Address: City State Zip Gender: Date of Birth (mm/dd/yyyy): SS Number Disclosure Required on separate form Home Telephone: Work Telephone: Email: Attorney’s Name: Bar ID#: CONTAINS NONPUBLIC DIGITAL INFORMATION MAINE JUDICIAL BRANCH ADA Notice: The Maine Judicial Branch complies with the Americans with Disabilities Act (ADA). If you need a reasonable accommodation contact the Court Access Coordinator, accessibility@courts.maine.gov, or a court clerk. Language Services: For language assistance and interpreters, contact a court clerk or interpreters@courts.maine.gov. FM-002, Rev. 07/20 Page 3 of 3 www.courts.maine.gov Family Matter Summary Sheet Minor Children (of above parties): Full name Date of Birth (mm/dd/yyyy) Gender SS Number Disclosure Required SS Number Disclosure Required SS Number Disclosure Required SS Number Disclosure Required SS Number Disclosure Required SS Number Disclosure Required Parentage Issues (if any): The child(ren) do not have any other acknowledged, adjudicated, intended, de facto, or presumed parents. OR The child(ren) have an acknowledged, adjudicated, intended, de facto, or presumed parent. (You must complete a separate summary sheet for every additional parent that your child has, and all parents must be served with a copy of the Complaint and made a party to your action.) Date (mm/dd/yyyy):  Signature of party party’s attorney CONTAINS NONPUBLIC DIGITAL INFORMATION

Family and Probate Matter Summary Sheet

MAINE JUDICIAL BRANCH ADA Notice: The Maine Judicial Branch complies with the Americans with Disabilities Act (ADA). If you need a reasonable accommodation contact the Court Access Coordinator, accessibility@courts.maine.gov, or a court clerk. Language Services: For language assistance and interpreters, contact a court clerk or interpreters@courts.maine.gov. FM-PB-009, Rev. 02/20 Page 1 of 2 www.courts.maine.gov Affidavit Plaintiff DISTRICT COURT Location (Town): V. Docket No.: Defendant OR IN RE: AFFIDAVIT I, __________________________________________________ (name), state the following facts, which are true to the best of my knowledge and belief: ( Please attach an additional page if necessary.) MAINE JUDICIAL BRANCH ADA Notice: The Maine Judicial Branch complies with the Americans with Disabilities Act (ADA). If you need a reasonable accommodation contact the Court Access Coordinator, accessibility@courts.maine.gov, or a court clerk. Language Services: For language assistance and interpreters, contact a court clerk or interpreters@courts.maine.gov. FM-PB-009, Rev. 02/20 Page 2 of 2 www.courts.maine.gov Affidavit I swear under penalty of perjury that the above statements are true and correct. I understand that these statements are made for use as evidence in court and that I am subject to prosecution for perjury punishable by up to 5 years in prison and a fine of up to $5,000 if I give false information to the court. Date (mm/dd/yyyy): ► Affiant Signature STATE OF MAINE _______________________ COUNTY Personally appeared the above named, ________________________________________ and made oath that the foregoing statements are true under penalty of perjury. Before me, Date (mm/dd/yyyy): ► Attorney at Law Notary Public Register Clerk

Affidavit

CONTAIN NONPUBLIC DIGITAL INFORMATION MAINE JUDICIAL BRANCH ADA Notice: The Maine Judicial Branch complies with the Americans with Disabilities Act (ADA). If you need a reasonable accommodation contact the Court Access Coordinator, accessibility@courts.maine.gov, or a court clerk. Language Services: For language assistance and interpreters, contact a court clerk or interpreters@courts.maine.gov. PB-003, Rev. 08/20 Page 1 of 3 www.courts.maine.gov Jurisdictional Affidavit DISTRICT COURT IN RE: ______________________________ Location (Town): _____________________ Docket No.: _________________________ JURISDICTIONAL AFFIDAVIT 4 M.R.S. § 152(5-A) Pursuant to 4 M.R.S. § 152(5-A), in order for the District Court to accept a for filing a petition for guardianship, adoption, or name change concerning a minor child, there must already be a pending case in the District Court concerning custody or other parental rights concerning that child, OR a case involving the child must have already been transferred from a Probate Court. A “pending” case is a case that has been filed in a District Court, is being litigated in that court, and/or is awaiting decision by that court. In order to assist the District Court in determining whether it has jurisdiction, you must provide the following information: 1.Pe titioner’s(s’) names(s), date(s) of birth (mm/dd/yyyy), address(es), and telephone number(s): __________________________________________________________________________________________ __________________________________________________________________________________________ 2.Petitioner(s) wish/es to file a guardianship, adoption, or name change case involving the following child(ren) (provide name, date of birth (mm/dd/yyyy), and address of minor child(ren)): __________________________________________________________________________________________ __________________________________________________________________________________________ 3. Relationship of petitioner(s) to minor child: ________________________________________________ __________________________________________________________________________________________ Petitioner(s) claim/s that the District Court has jurisdiction over this case because (“X” all that are true): A. There is a case concerning the child(ren) that is currently pending before a Maine District Court. The case name is _______________________________________________________, docket number , and it is pending in the District Court. B. There is a second case concerning the child(ren) that is currently pending before a Maine District Court. The case name is ________________________________________________, docket number , and it is pending in the District Court. M inor Child CONTAIN NONPUBLIC DIGITAL INFORMATION MAINE JUDICIAL BRANCH ADA Notice: The Maine Judicial Branch complies with the Americans with Disabilities Act (ADA). If you need a reasonable accommodation contact the Court Access Coordinator, accessibility@courts.maine.gov, or a court clerk. Language Services: For language assistance and interpreters, contact a court clerk or interpreters@courts.maine.gov. PB-003, Rev. 08/20 Page 2 of 3 www.courts.maine.gov Jurisdictional Affidavit C. Although there is no pending case in the District Court, a guardianship, adoption, or name change case concerning the child was transferred from a Probate Court to the District Court. The name of that case is , its docket number is and it was transferred from Probate Court to the District Court. 4. There is is not a guardianship, adoption, or name change case concerning the minor child that is currently pending before any Maine Probate Court. 5. There is is not a judgment or order issued by the Court that currently affects the care and custody of the child(ren). A copy of that order is attached. 6. Name, date of birth (mm/dd/yyyy), address, and telephone number of all the child’s legal parents: ___________ _______________________________________________________________________________ __ ________________________________________________________________________________________ __________________________________________________________________________________________ __ ________________________________________________________________________________________ 7. Name, da te of birth (mm/dd/yyyy), address, and telephone number of child’s guardian, custodian, or anyone else with custody claims to the child: __________________________________________________________________________________________ __________________________________________________________________________________________ I understand that, if I give false information on this form, I may be subject to a determination that I am in contempt of court, and I may be sanctioned for that contempt. I swear under penalty of perjury that the above statements are true and correct. I understand that these statements are made for use as evidence in court and that I am subject to prosecution for perjury punishable by up to 5 years in prison and a fine of up to $5,000 if I give false information to the court. Date (mm/dd/yyyy): ► Petitioner Signature Date (mm/dd/yyyy): ► Petitioner Signature CONTAIN NONPUBLIC DIGITAL INFORMATION MAINE JUDICIAL BRANCH ADA Notice: The Maine Judicial Branch complies with the Americans with Disabilities Act (ADA). If you need a reasonable accommodation contact the Court Access Coordinator, accessibility@courts.maine.gov, or a court clerk. Language Services: For language assistance and interpreters, contact a court clerk or interpreters@courts.maine.gov. PB-003 , Rev. 08/20 Page 3 of 3 www.courts.maine.gov Jurisdictional Affidavit STATE OF MAINE , County Personally appeared the above-named ________________________________________ and ___________________________________________, and made oath that the foregoing statements are true under penalty of perjury. B efore me, Date (mm/dd/yyyy): ► Attorney at Law Notary Public Register Clerk

Jurisdictional Affidavit

CONTAINS NONPUBLIC DIGITAL INFORMATION MAINE JUDICIAL BRANCH ADA Notice: The Maine Judicial Branch complies with the Americans with Disabilities Act (ADA). If you need a reasonable accommodation contact the Court Access Coordinator, accessibility@courts.maine.gov, or a court clerk. Language Services: For language assistance and interpreters, contact a court clerk or interpreters@courts.maine.gov. PB-004, Rev. 09/19 Page 1 of 1 www.courts.maine.gov Social Security Number Confidential Disclosure Form 1 IN RE: _________________________ DISTRICT COURT Minor Name Location ( Town): Docket No.: SOCIAL SECURITY NUMBER CONFIDENTIAL DISCLOSURE FORM M y Social Security account number is __________________ - _________ - ______________________. Date (mm/dd/yyyy): ► Petitioner Respondent Minor’s Name Social Security Number A Protective Custody case is currently pending. Docket No.: ____________________________________ P LEASE NOTE: This form is confidential and shall not be disclosed unless ordered by the Court.

SSN Disclosure Form (AD,GS,NC)

CONTAINS NONPUBLIC D IGITAL I NFORMATION MAINE JUDICIAL BRANCH ADA Notice: The Maine Judicial Branch complies with the Americans with Disabilities Act (ADA). If you need a reasonable accommodation contact the Court Access Coordinator, accessibility@courts.maine.gov, or a court clerk. Language Services: For language assistance and interpreters, contact a court clerk or interpreters@courts.maine.gov. PB-007, Rev. 02/20 Page 1 of 5 www.courts.maine.gov Order Appointing Guardian Ad Litem (GAL) for Minor(s) IN RE: DISTRICT COURT Location (Town): Docket No.: Name(s) of Minor Children ORDER APPOINTING GUARDIAN AD LITEM (GAL) FOR MINOR(S) 18-C M.R.S. § 1-111(1) Limited-Purpose Standard Expanded 1. Pursuant to 18-C M.R.S. § 1-111(1), and subject to the conditions set forth below, the court appoints a guardian ad litem (GAL) for the following minor child(ren), whose name(s) and date(s) of birth is/are: _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ 2. The GAL’s name is: _______________________________________________________________________________ The GAL’s contact information is: ___________________________________________________________________ ____________________________________________________________________ The GAL appointed by the court and listed above is currently on the roster of qualified Maine GALs; or The GAL appointed by the court and listed above is a qualified attorney licensed to practice in Maine who is not currently listed on the GAL roster. The following findings establish good cause for appointing an unrostered GAL: the GAL has the necessary skills and experience in family or guardian matters (see M.R.G.A.L. 2(a)(1)), or other qualifications: ________________________________________________________________________ _________________________________________________________________________________________ 3. No party objects to the GAL appointment or the fee arrangements specified below; or Petitioner Respondent Other ( ____________________________ ) objects to the appointment of a GAL but, after careful consideration, the court concludes the following factors in 4 M.R.S. § 1555(1)(B) support the appointment:________________________________________________________________________________ ___________________________________________________________________________________________ _____________________________________________________________________________________and/or: Petitioner Respondent Other ( ____________________________ ) objects to the fee arrangement below but, after careful consideration, the court c oncludes the following factors in M.R.G.A.L. 4(b)(4)(C) support the fee arrangement: CONTAINS NONPUBLIC D IGITAL I NFORMATION MAINE JUDICIAL BRANCH ADA Notice: The Maine Judicial Branch complies with the Americans with Disabilities Act (ADA). If you need a reasonable accommodation contact the Court Access Coordinator, accessibility@courts.maine.gov, or a court clerk. Language Services: For language assistance and interpreters, contact a court clerk or interpreters@courts.maine.gov. PB-007, Rev. 02/20 Page 2 of 5 www.courts.maine.gov Order Appointing Guardian Ad Litem (GAL) for Minor(s) TYPE OF GAL APPOINTMENT, GAL’s INVESTIGATIVE DUTIES, AND GAL’s RESPONSIBILITY FOR WRITTEN REPORT 4. TYPE OF APPOINTMENT (choose A, B, or C) A. Limited-Purpose Appointment. i. Duties. The GAL must perform the following specific duties: The GAL shall appear at the interim hearing final hearing in this matter to testify and be available for cross-examination. ii. Other provisions of the limited appointment: ___________________________________________________ The GAL shall not perform and is not expected to perform any duties beyond those specified in this order (including responding to telephone calls, emails, and other communications from the parties) unless or until a new order is entered. B. Standard Appointment. i. Duties. The GAL shall appear at the final hearing in this matter to testify and to be available for cross- examination. Before the hearing, the GAL must perform the following specific duties: Observe the child(ren) in the home or home where the child(ren) regularly live, and for a child over age 3, conduct a face-to-face interview with the child; and Interview the petitioner, each parent, and any adult who lives in the home(s) where the child(ren) regularly live. ii. Other provisions of the standard appointment: __________________________________________________ The GAL shall not perform and is not expected to perform any duties beyond those specified in this order (including responding to telephone calls, emails, and other communications from the parties) unless or until a new order is entered. C. Expanded Appointment. i. Duties. Until this appointment ends, the GAL shall appear at all hearings in this matter to testify and to be available for cross-examination. Before the hearing, the GAL must perform the following specific duties: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Observe the child(ren) in the home or homes where the child(ren) regularly live, and for a child over age 3, conduct a face- to-face interview with the child; and Interview the petitioner, each parent, and any adult who lives in the home(s) where the child(ren) regularly live. Interview the following teachers and other people who know about the child(ren) or family: _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ CONTAINS NONPUBLIC D IGITAL I NFORMATION MAINE JUDICIAL BRANCH ADA Notice: The Maine Judicial Branch complies with the Americans with Disabilities Act (ADA). If you need a reasonable accommodation contact the Court Access Coordinator, accessibility@courts.maine.gov, or a court clerk. Language Services: For language assistance and interpreters, contact a court clerk or interpreters@courts.maine.gov. PB-007, Rev. 02/20 Page 3 of 5 www.courts.maine.gov Order Appointing Guardian Ad Litem (GAL) for Minor(s) Review ______________________________’s mental health medical and/or educational records. Review ______________________________’s mental health medical and/or educational records. Review ______________________________’s mental health medical and/or educational records. Review ______________________________’s mental health medical and/or educational records. Review ______________________________’s mental health medical and/or educational records. Review ______________________________’s mental health medical and/or educational records. Engage a qualified medical mental health educational provider to evaluate: ________________________________ by (mm/dd/yyyy) ______________ with the cost to be no more than $ _____________ By (mm/dd/yyyy)___________________, arrange counseling for the following child(ren): _____________________________________________________________________________________ Subpoena witnesses and documents and examine and cross-examine witnesses; Serve as a contact person between the parent(s) / petitioner(s), and the child(ren) as follows: ________________________________________________________________________________________ ________________________________________________________________________________________ Appear at mediation (in person) and/or status conference (telephonically) and/or other court-r elated event(s) listed here: _________________________________________________________ Other duties: _ _________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ii. Other provisions of the expanded appointment: _______________________________________________________________________________________ _______________________________________________________________________________________ The GAL shall not perform and is not expected to perform any duties beyond those specified in this order (including responding to telephone calls, emails, and other communications from the parties) unless or until a new order is entered. 5. LENGTH OF APPOINTMENT This GAL appointment ends at the end of the interim hearing final hearing upon entry of a final judgment upon further order of the court, or on (mm/dd/yyyy) ___________________. 6. WRITTEN REPORT (Choose one): The GAL is not required to submit a written report before testifying at the hearing (limited appointments only); The GAL shall provide a summary written or oral report with preliminary findings and preliminary recommendations to the parties on or before (mm/dd/yyyy)___________________; The GAL shall submit a written report to the court and to the parties 14 days before the hearing or (mm/dd/yyyy)___________________, unless the GAL has been notified that the case has settled, in which case no written report is required. If the GAL is notified by a party or the court that the case has settled before the GAL has completed the written report, the GAL may not bill the parties for any further work on the written report. CONTAINS NONPUBLIC D IGITAL I NFORMATION MAINE JUDICIAL BRANCH ADA Notice: The Maine Judicial Branch complies with the Americans with Disabilities Act (ADA). If you need a reasonable accommodation contact the Court Access Coordinator, accessibility@courts.maine.gov, or a court clerk. Language Services: For language assistance and interpreters, contact a court clerk or interpreters@courts.maine.gov. PB-007, Rev. 02/20 Page 4 of 5 www.courts.maine.gov Order Appointing Guardian Ad Litem (GAL) for Minor(s) The written report must include the results of the GAL’s investigation and the GAL’s recommendations on the following issues: 7. FEE ARRANGEMENT For all cases, the GAL shall use the standardized billing, itemization requirements, and time reporting processes established by the Family Division. If the fee is not paid in accordance with this order, the GAL shall notify the court and the parties, and the court may vacate the appointment or take such other action it deems appropriate under the circumstances. A. Fees to be paid by the court. Because the GAL’s fees are to be paid by the court, those fees will be paid pursuant to either: 1. The guidelines contained in AO-JB-05-5 (for matters in District Court); or 2. $ ________/hour for time not to exceed __________ hours without further authorization of the court (for matters in Probate Court). The GAL shall submit invoices to the court of disposition using the current court-approved voucher form. B. Fees to be paid by parties. i. The total fee the GAL may receive is as follows (choose one): Flat fee: The GAL will complete all the duties required in this appointment order until mediation is completed, for a flat fee of $__________. If the GAL is required to attend a hearing and provide a final written report, the additional flat fee will be $____________. Hourly rate with cap: The GAL may charge a total fee of no more than $ ____________, by spending no more than __________ total hours on this matter at the hourly rate of $ ___________/hour until mediation is completed. If the GAL is required to attend a hearing an provide a final written report, the GAL may charge an additional fee of no more than $ _______________. ii. The GAL’s fee shall be paid as follows: On or before (mm/dd/yyyy) _______________ , Petitioner shall pay $ _____________, Respondent shall pay $ _______________, Other ( __________________________ ) shall pay $ _____________. The responsibility for payment may be changed at the final hearing. In addition, the GAL shall submit an itemized bill to the parties on a monthly bi -weekly basis. Petitioner shall pay ________ % of each bill, Respondent shall pay _______ % of each bill, Other ( ___________________________ ) shall pay _________ % of each bill. The responsibility for payment may be changed at the final hearing. Each party shall pay the GAL within 14 35 days after receiving each bill; or Petitioner shall pay $ __________ per week month toward the GAL fees and expenses, Respondent shall pay $ ___________ per week month toward the GAL fees and expenses, Other ( ) shall pay $ ____________ per week month toward the GAL fees and expenses. The responsibility for payment may be changed at the final hearing. The final fee payments shall be made within 14 days after the filing of the written report or, if no written report is required because the case has settled, within 14 days after the court has adopted the settlement. CONTAINS NONPUBLIC D IGITAL I NFORMATION MAINE JUDICIAL BRANCH ADA Notice: The Maine Judicial Branch complies with the Americans with Disabilities Act (ADA). If you need a reasonable accommodation contact the Court Access Coordinator, accessibility@courts.maine.gov, or a court clerk. Language Services: For language assistance and interpreters, contact a court clerk or interpreters@courts.maine.gov. PB-007, Rev. 02/20 Page 5 of 5 www.courts.maine.gov Order Appointing Guardian Ad Litem (GAL) for Minor(s) C. No additional hours or fees will be authorized or approved for any type of appointment without prior court approval through and amended or new order of appointment. 8. GENERAL PROVISIONS APPLICABLE TO ALL GAL APPOINTMENTS A. The GAL shall not perform and is not expected to perform any duties beyond those specified in this order (including responding to telephone calls, emails, and other communications from the parties) unless or until an amended or new order is entered. B. The GAL has quasi-judicial immunity from liability resulting from actions undertaken pursuant to her/his appointment. C. The GAL shall make the wishes of the child(ren) known to the court if the child(ren) has/have expressed them, regardless of the recommendation of the GAL. D. Given the confidential nature of the material that may be reviewed by the GAL, all of the GAL’s reports shall be confidential and sealed after the report is submitted to the court and to the parties. Neither the information contained in the reports not the reports themselves shall be disclosed or published by the parties or the GAL or further released by the court, except to the representatives of the GAL Review Board actively investigating a complaint against a GAL, or as otherwise ordered by the court. E. The parties in this matter shall fully cooperate with the GAL’s investigation, including, but not limited to, participating in interviews, making themselves and the child(ren) available to the GAL at such reasonable times and places as he or she may request for the purposes of carrying out the duties specified in this appointment order, and signing releases permitting the GAL to access all medical, mental health, or educational records that the GAL has been ordered (above) to review. F. The GAL may advocate for special procedures to protect the child(ren) witness(es) from unnecessary psychological harm resulting from the child(ren)’s testimony, with or without the consent of the parties. 9. GENERAL PROVISIONS APPLICABLE TO ALL CASES A. The parties SHALL not try to influence or pressure the child(ren) who are involved in this litigation. No party shall tell the child(ren) how to talk with or what to say to the GAL or the court. B. If any party has serious concerns about a guardian ad litem, you may file a complaint pursuant to M.R.G.A.L. 9(d) with the Guardian ad Litem Review Board. The complaint form and directions on how to file a complaint with the Guardian ad Litem Review Board can be found at http://www.mebaroverseers.org/complaint/GAL- Complaint.html. The Clerk is directed to incorporate this Order by reference into the docket for this case, pursuant to Rule 79(a), Maine Rules of Civil Procedure. Date (mm/dd/yyyy): ► Judge, Maine District Court

Order Appointing Guardian Ad Litem (GAL) for Minor(s)

CONTAINS NONPUBLIC DIGITAL INFORMATION MAINE JUDICIAL BRANCH ADA Notice: The Maine Judicial Branch complies with the Americans with Disabilities Act (ADA). If you need a reasonable accommodation contact the Court Access Coordinator, accessibility@courts.maine.gov, or a court clerk. Language Services: For language assistance and interpreters, contact a court clerk or interpreters@courts.maine.gov PB-010, Rev. 09/20 Guardianship Case File Checklist Page 1 of 2 www.courts.maine.gov GUARDIANSHIP CASE FILE CHECKLIST *As of September 1, 2019, the courts will accept only 18-C forms (Rev. 9/19 or after) Required at the time of filing: FILING FEE $50 or CV-067/191 Application to Proceed Without Payment of Fees and Financial Affidavit FM-002 Family and Probate Matter Summary Sheet PB-004 Social Security Number Confidential Disclosure Form(s) PB-003 Jurisdictional Affidavit Petition (check one) GS-001 Petition for Appointment of Guardian of Minor IF APPLICABLE: GS-003 Motion for Appointment of Guardian of Minor on an Emergency Basis (note: GS-003 can be filed only if GS-001 is filed at the same time or beforehand.) GS-009 Petition for Modification/Termination/Removal/Resignation of Guardian(ship) GS-008 Acceptance of Appointment by Guardian of Minor Please note: At the time of filing, the petitioner(s) will receive a date for the initial court appearance on the Petition and, if applicable, a date for the hearing on the Motion for Appointment of Guardian on an Emergency Basis. Thereafter, the petitioner(s) must serve the petition, hearing date(s), and other accompanying forms on the respondent(s). If GS-003 Motion for Appointment of Guardian of a Minor on an Emergency Basis is filed with GS-001 at case filing or any time thereafter: Required after the Judge reviews the motion: If the Court makes an ex-parte a ppointment, the petitioner(s) must provide notice of the following to all respondents: GS-004 Order Appointing Guardian of Minor on an Emergency Basis GS-013 Letters of Guardianship GS-005 Notice of Appointment and Order Setting Hearing on Petition for Appointment of Guardian of Minor on Emergency Basis If the Court does not make an ex-parte appointment, the petitioner(s) must provide notice of the GS- 019 Order Setting Hearing to all respondents. Required BEFORE the hearing on the motion for emergency appointment: GS-006 Affidavit of Notice (to be reviewed by the Judge). CONTAINS NONPUBLIC DIGITAL INFORMATION MAINE JUDICIAL BRANCH ADA Notice: The Maine Judicial Branch complies with the Americans with Disabilities Act (ADA). If you need a reasonable accommodation contact the Court Access Coordinator, accessibility@courts.maine.gov, or a court clerk. Language Services: For language assistance and interpreters, contact a court clerk or interpreters@courts.maine.gov PB-010, Rev. 09/20 Guardianship Case File Checklist Page 2 of 2 www.courts.maine.gov Required to be filed BEFORE the final hearing on the petition may be held: PB-008 Summons Adoption, Guardianship, and Name Change with Proof of Service (acknowledgement, green mail card, or sheriff return of service) Proof of Service (check all that apply) Minor aged 14 or over Primary caretaker during previous 60 days Any living parent, or if none, the nearest kinship adult that can be found Any person nominated to be guardian by the minor Any appointee of a parent whose appointment has not been prevented or terminated Any guardian or conservator currently acting for the minor in this state or anywhere else GS-017 Child Support Affidavit GS-018 Child Support Worksheet

Guardianship Case File Checklist

CONTAINS NONPUBLIC DIGITAL INFORMATION MAINE JUDICIAL BRANCH ADA Notice: The Maine Judicial Branch complies with the Americans with Disabilities Act (ADA). If you need a reasonable accommodation contact the Court Access Coordinator, accessibility@courts.maine.gov, or a court c lerk. Language Services: For language assistance and interpreters, contact a court clerk or interpreters@courts.maine.gov. PB-011, Rev. 09/20 Private Party Adoption Case File Checklist Page 1 of 2 www.courts.maine.gov PRIVATE PARTY ADOPTION CASE FILE CHECKLIST *As of September 1, 2019, the courts accept only 18-C forms (Rev. 9/19 or after) Required at the time of filing: FILING FEE $65.00; or CV-067/191 Application to Proceed Without Payment of Fees and Financial Affidavit FM-002 Family and Probate Matter Summary Sheet PB-004 Social Security Number Confidential Disclosure Form PB-003 Jurisdictional Affidavit AD-001 Petition for Adoption and Change of Name AD-012 Petition to Terminate Parental Rights ( if applicable) AD-007 Confidential Statement to Accompany Petition for Adoption Certified Copy of Adoptee’s Birth Certificate or delayed birth registration Required BEFORE final hearing: PLEASE NOTE: The Petition for Adoption must always be served on parents whose rights have not been terminated or surrendered and released. PB-008 Summons Adoption, Guardianship, and Name Change with Proof of Service (acknowledgement, green mail card, or sheriff service) of applicable parties. AD-004 Consent of Person to be Adopted (applicable if adoptee is 12 years or older) AD-008 Report of Disbursements (not applicable if one of the petitioners is a blood relative to the minor) Marriage License (if applicable and not included in the Home Study) Divorce Decrees (if applicable) Home Study Background and History of the Adoptee CONTAINS NONPUBLIC DIGITAL INFORMATION MAINE JUDICIAL BRANCH ADA Notice: The Maine Judicial Branch complies with the Americans with Disabilities Act (ADA). If you need a reasonable accommodation contact the Court Access Coordinator, accessibility@courts.maine.gov, or a court c lerk. Language Services: For language assistance and interpreters, contact a court clerk or interpreters@courts.maine.gov. PB-011, Rev. 09/20 Private Party Adoption Case File Checklist Page 2 of 2 www.courts.maine.gov DHHS Family and Child Health History (Parent 1) Parent 1 refused to provide this information. DHHS Family and Child Health History (Parent 2) Parent 2 refused to provide this information. AD-005 Consent of Parent to Adoption of Parent 1 (or if Parent 1 is outside main, AD-006 Consent of Parent to Adoption, Outside Maine) and AD-009 Certificate of Counseling for Parent 1; or If Parent 1 is deceased, copy of Death Certificate If Parent 1 executed a surrender and release, AD-015 Surrender and Release to Adoption and AD-009 Certificate of Counseling for Parent 1; or Order Terminating Parental Rights of Parent 1 AD-005 Consent of Parent to Adoption of Parent 2 (or if Parent 1 is outside main, AD-006 Consent of Parent to Adoption, Outside Maine) and AD-009 Certificate of Counseling for Parent 2; or If Parent 2 is deceased, copy of Death Certificate; If Parent 2 executed a surrender and release, AD-015 Surrender and Release to Adoption and AD-009 Certificate of Counseling for Parent 2; or Order Terminating Parental Rights of Parent 2. Application and Agreement for Adoption Assistance VS-9 Certificate of Adoption, with numbers 1-62 completed (numbers 63-67 to be completed by clerk after final hearing) CJIS Fingerprint/Background Check Results PLEASE NOTE: If the court issues an adoption decree after the final hearing, the clerk will send the court order and the completed VS-9 form to the petitioning party. The petitioning party must then mail the completed VS-9 form with a $60 check or money order payable to Treasurer, State of Maine to: Department of Health and Human Services Maine Center for Disease Control and Prevention 220 Capitol Street 11 State House Station Augusta, Maine 04333-0011

Private Party Adoption Case File Checklist

CONTAINS NONPUBLIC DIGITAL INFORMATION MAINE JUDICIAL BRANCH ADA Notice: The Maine Judicial Branch complies with the Americans with Disabilities Act (ADA). If you need a reasonable accommodation contact the Court Access Coordinator, accessibility@courts.maine.gov, or a court c lerk. Language Services: For language assistance and interpreters, contact a court clerk or interpreters@courts.maine.gov. Page 1 of 1 www.courts.maine.gov PB-012, Rev. 09/20 Minor Name Change Case File Checklist MINOR NAME CHANGE CASE FILE CHECKLIST *As of September 1, 2019, the courts accept only 18-C forms (Rev. 9/19 or after) Required at the time of filing: FILING FEE $40.00; or CV-067/191 Application to Proceed Without Payment of Fees and Financial Affidavit FM-002 Family and Probate Matter Summary Sheet PB-004 Social Security Number Confidential Disclosure Form PB-003 Jurisdictional Affidavit NC-001 Petition for Adoption and Change of Name Required BEFORE final hearing: PB-008 Summons Adoption, Guardianship, and Name Change with Proof of Service (acknowledgement, green mail card, or sheriff service) of applicable parties. Certified copy of birth certificate of minor C opy of divorce judgment, and any modifications, if any Court order pertaining to custody of the minor, and any modifications, if any Death certificate of deceased custodian, if any VS-14 Legal Name Change (LNC) Request to Amend a Vital Record with parts 1, 2, and 3 completed (parts 4 and 5 to be completed by clerk after final hearing). PLEASE NOTE: If the court issues a minor name change order after the final hearing, the clerk will send the court order and the completed VS-14 form to the petitioning party. The petitioning party must then mail the completed VS-14 form with a $60 check or money order payable to Treasurer, State of Maine to: Department of Health and Human Services Maine Center for Disease Control and Prevention 220 Capitol Street 11 State House Station Augusta, Maine 04333-0011

Name Change Case File Checklist

MAINE JUDICIAL BRANCH ADA Notice: The Maine Judicial Branch complies with the Americans with Disabilities Act (ADA). If you need a reasonable accommodation contact the Court Access Coordinator, accessibility@courts.maine.gov, or a court clerk. Language Services: For language assistance and interpreters, contact a court clerk or interpreters@courts.maine.gov. Page 1 of 1 www.courts.maine.gov PB-013, Rev. 01/21 Instructions for Submission of VS-9 or VS-14 Form to Vital Records I NSTRUCTIONS FOR SUBMISSION OF VS-9 OR VS-14 FORM TO VITAL RECORDS In order to get a new birth certificate for your child, you must mail the following paperwork to Vital Statistics: The completed VS-9 (used in minor adoption cases) or VS-14 form (used in minor name change cases); A certified copy of the court judgment; and A $60 check or money order made payable to Treasurer, State of Maine. The complete mailing must be sent to the following address: Department of Health and Human Services Maine Center for Disease Control and Prevention 220 Capitol Street 11 State House Station Augusta, Maine 04333-0011

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