Art. 1515. Petition; contents; form
A. A petition for voluntary transfer of custody shall set forth specifically:
(1) The name and address of all parents and legal custodians.
(2) An affirmation that the parents are knowingly and voluntarily transferring custody.
(3) The full name and date of birth of the child whose custody is sought to be transferred.
(4) The factual basis for the transfer of custody.
(5) The nature, duration, and extent of the transfer of custody, including any terms and conditions.
(6) The name and address of the agency, institution, or individual to whom the child is sought to be transferred and the relationship, if any, to the child.
(7) Whether the Department of Children and Family Services has recommended a petition for voluntary transfer of custody be filed.
B. The form for the petition shall be as follows:
"PETITION FOR VOLUNTARY TRANSFER OF CUSTODY
The petition of ____________________________ (all legal custodians of the child unless otherwise indicated in Paragraph III of the petition), domiciled in the parish of _________________, respectfully represent(s):
I.
That petitioner(s) reside at the following address(es):
___________________________________________________________
___________________________________________________________
II.
That petitioner(s) is/are the parent(s) and legal custodian(s) of the minor child(ren), namely _______________________________, whose date of birth is ______________ (add same information for all children subject to the petition), as more fully appears from the attached certificate(s) of birth.
III.
That there are no other legal custodians of the child(ren) OR that a legal custodian, namely _______________________, is unable to join in this petition for the following reasons:
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
______________________________________________________________.
IV.
That petitioner(s) desire(s) to knowingly and voluntarily transfer custody of the above named children to ____________________________, which individual(s), institution or agency reside(s) at the following address:
________________________________________________________ and who have the following relationship with the children:
_______________________________________________________________
______________________________________________________________.
V.
That petitioner(s) desire to transfer physical custody OR legal custody OR guardianship of the person of the children (indicate one) for the period of time __________________________________________ (specify intended duration) in accordance with the following terms and conditions: _________
______________________________________________________________
______________________________________________________________
______________________________________________________________
(may include provisions for support and/or visitation).
VI.
That petitioners desire this transfer of custody for the following reasons: ______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________.
Has the Department of Children and Family Services, office of children and family services, or child protective services recommended to you that this petition be filed?
________
_______
Yes
No
If yes, state name of the Department of Children and Family Services worker making the recommendation and the reasons for the recommendation with particularity.
If the department has recommended that this petition be filed, you have a right to counsel. Have you consulted with an attorney?
________
_______
Yes
No
VII.
That ________________________ has/have agreed to and does/do desire to accept custody of the child(ren) to the extent and under the terms and conditions stated in this petition, as more fully appears in the attached Affidavit of Acceptance.
WHEREFORE, petitioner(s) pray(s) that there be judgment herein transferring custody of the child(ren), _______________, _____________, ________________, ________________, to ________________________, to the extent and under the terms and conditions set forth in this petition.
________________________________
(Signature and address of Petitioner(s))
or counsel for Petitioner(s)
(If in proper person, petition should be signed in presence of a notary.)
SWORN TO AND SUBSCRIBED BEFORE ME ON THIS THE _____ DAY OF ___________________, 19___.
____________________________
NOTARY PUBLIC"
Acts 1991, No. 235, §15, eff. Jan. 1, 1992; Acts 2010, No. 266, §1.