"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):
That petitioner(s) reside at the following address(es):
________________________________________________________________________
________________________________________________________________________
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.
Is the child an Indian child?
____ ____
Yes No
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:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
_______________________________________________________________________.
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:
________________________________________________________________________
________________________________________________________________________.
That petitioner(s) desire to transfer physical custody OR legal custody 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).
That petitioners desire this transfer of custody for the following reasons: ________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
_________________________________________________________________________
________________________________________________________________________.
Has the Department of Children and Family 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
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 ___________________, 20 ___.
____________________________
NOTARY PUBLIC"
La. Ch.C. § 1515