HomeMy WebLinkAbout98-07091
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l\DOPTION SEHVICES, INC.,
Plaint if f
IN THE COURT OF COM~lON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
NO. 'I J- ''/:1; IF,,,, ,', -r-' ,,--
v.
fJlAURICE G. BLANCHETTE and
FRANKIE SUE BLANCHETTE,
husband and wife,
Defendants
CIVIL ACTION - IN EQUITY
NOT
C E
I
YOU HAVE BEEN SUED IN COURT. If you wish to defend against the
claims set forth il1 the following pages, you must take action within
twenty (20) days after this Complaint and Notice are served, by
entering a written appearance personally or by attorney and filing 1n
writing with the Court your defenses or objections to the claims set
forth against you. You are warned that if you fail to do so the case
may proceed without you and a judgment may be entered against you by
the Court without further notice for any money claimed in the
Complaint or for any other claim or relief requested by the Plaintiff.
You may lose money or property or other rights important to you.
YOU SHOULD TAKE THIS PAPER TO YOUR LAI.,YER AT ONCE. IF YOU DO NOT
HAVE A LAI.,YER OR CANNOT AFFOIW ONE, GO TO OR TELEPHONE THE OFFICE SET
FORTH BELO!., TO FIND OUT \-IHERE YOU CAN GET LEGAL HELP.
Cumberl.:lI1d County Bar Association
2 Liberty Avenue
Carlisle, PA 17013
(717) 249-3166
NOT
I
C
A
I
Le han demandado a usted en la corte. 8i usted quiere defenderse
de estas demandas expuestas en Jas paginas siguientes, usted tiene
viente (20) dias de plazo al partir de la facha de la demanda y la
notificacion. Usted debe presentar una apariencia
escrita 0 en Persona 0 por abogado y archivar en la corte en forma
escrita sus defensas 0 sus objectiones alas demandas encontra de su
persona. Sea avisado que si usted no se defiende, la corte tamara
medidas y puede entrar una orden contra usted sin previo aviso 0
notiflcacion y por cualquier queja 0 alivio que es pedido en la
peticion de demanda. Usted puede perder dinero 0 sus propiedades 0
otro3 derechos import311tes para usted.
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M){WI'!UN ::I,:FV](,'ES, TNC.,
P] '11ntiff
IN THE COURT OF COMMON PLEAS
CUMBERL~,D COUNTY, PENNSYLVANIA
,C
L.7'~"<: 17 L"-
{, '
v.
NO.
'I S. '/0 ell
r~^I'I~ 1 ('E f,:. BLANCHETTE Llnd
FI"A1JI( II,; ::IJl'; BLMJCIIETTE,
11\1:1I101I1d oIlld vii jo"
DcfendLlnts
CIVIL ACTION - IN EQUITY
COMPLAINT
/\1W NOl'i COllies ADOPTION SERVICES, INC., by its attorneys SMIGEL,
ANj)EI~I;c)N & SACKS, and avel'S the following:
COUNT I - SPECIFIC PERFORMANCE
1. Plaintiff is Adoption Services, Inc., an adoption agency
] iC(;Jwf!d in the Commonwealth of Pennsylvania, with j,ts principal
"I f. iL'.' ,j \ ;, EJ Cent r,;) Boulevard, Camp Hill, Cumberland County,
!l/.'lll1:,Y] vanit-J..
~. Defendants are Maurice G. Blanchette and Frankie Sue
Bl~nchette, husband and wife, whose current address is 8105 Bear Hill
Ro~d, Royse City, Texas 75189.
3. Plil int iff provides adopt ion services, inel uding intermediary
'3C'J'V1Ce'J to arrange adoptions between biological parents and adopting
pdJ:ent:3.
4. The services of the Plaintiff were provlded to Defendant
pursuant to a contract, which was executed by the Defendants at the
offices of the Plaintiff on August 11, 1997. A copy of the contract,
entitled Prospective Adopting Parents Contract, is at~ached hereto ilS
E~:hibiL "1",
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5. Pursuant to the Contract, the plaintiff placed two children
for adoption with the Defendants on August 14, 1997. For purposes of
this Complaint, the children are referred to as Dylan and Daniel.
6. The two children were adopted by the Defendants before the
Cumberland County Court on November 10, 1997.
7. paragraph 17 of the Contract requires, inter alia, the
Defendants to provide pictures and updates about the children to
plaintiff for approximately eighteen years.
8. Defendants are aware that the requirement for pictures and
updates 1S a contractual requirement and is also relied upon by the
biological mother.
9. plaintiff has made numerous and repeated requests to the
Defendants to provide the pictures and updates, but they have refused
or failed to do so.
10. Paragraph 20 of the Contract obligates the Defendants to
pay, inter alia, any and all legal fees incurred by Adoption Services,
Inc. to enforce the Contract.
l'IHEREFORE, plaintiff prays this Honorable Court to ent.er an Order
requiring the Defendants to comply wit.h Paragraph 17 of the Contract
to supply pictures and updates for the duration of the time specified
in the contract, and to pay reasonable counsel fees incurred by the
plaintiff, toget.her with costs.
COUNT II -IN ASSUMPSIT
J 1. Plaintiff hereby inC'orl'orater" che averrncmts of ~.Jaragl-aph~; 1
t hrouClh 10 by reference, ,)s if mOl'e Eull y 8;et out herea iter.
- 2 -
12. Pursuant to the Contract of August II, 1997, the Defendants
have failed to pay Plaintiff, for services r~ndered, the sum of
$16,361.00, evidenced by the invoice dated November 25, 1998, attached
hereto as Exhibit "2" and incorporated herein by reference.
13. Despite numerous demands by Plaintiff, Defendants have
failed or refused to pay for the services rendered as set forth in
Exhibit "2".
14. Plaintiff also placed two other children with Defendants for
which there are outstanding balances owed.
15. In 1996, Plaintiff placed a child with the Defendants, said
child known as Taylor, who was also adopted by the Defendants in 1997
before this Court.
16. There remains a balance due of $95.00 for the placement of
Taylor, as represented by the invoice attached hereto as Exhibit "3".
17. Despite numerous and repeated requests by the Plaintiff,
Defendants have failed or refused to pay the $95.00 due as represented
by the invoice attached hereto as Exhibit "3".
18. In 1997, the Plaintiff placed a child with the Defendants,
said child known as Dominic, who ~as also adopted before this
Honorable Court in 1997.
19. For the placement of Dominic, there remilins a balance due of
$100.00, as represented by the invoice attached hereto as Exhibit "4".
20. Despite numerous and repeated requests by the Plaintiff,
Defendants have failed or rcfu~,~ed to pay the 8100.00 due, Z:.IS
represented by the invoi ce <it tdched hereto (J," Exhibi t ",.".
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VERIFICATION
I, Vincent F. Bel'ger, Ph.D., President of Adopcion Services,
Inc., a licensed adoption agency in the Commonwealth of Pennsylvania,
verify that the statements contained in the foregoing Complaint are
true and correct to the best of my knowledge, information and belief.
I understand that false statements therein are made subject to the
penalties of 18 Pa.C.S. 34904, relating to unsworn falsification to
authorities.
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Date:
December
.r,
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// I .---
V Io{~ 6z~::/7'- (,2)R'~~
Vincent F. Berger, h.D.,
ADOPTION SERVICES, INC.
28 Central Boulevard
Camp Hill, PA 17011
President
1998
,.
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,., Adoption Services, Inc.
,. .28 Central Boulevard' Camp Hill, PA 17011' (717) 737-3960' FAX (717) 731-0157
PROSPECTIVE ADOPTING pARENTS CONTRACT
~
We (I),
parents and request
state that we (I):
the undersigned, are interested in becoming adoptive
the assistance of Adoption Services. Accordingly, we (I)
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1. have read and understand the current Adoption Services program
Description and Fee and service Schedule;
2. state that, with the exception of the information as specifically stated
in the Program Description and Fee and service Schedule, no promises
and/or guarantees of any kind have been made or implied to us (me) by
Adoption Services or its staff;
3. understand that we (I) will be notified of any changes in the current
Fee and Service Schedule that will apply to us (me) and agree to pay
Adoption Services for services rendered in accordance with the Fee and
Service Schedule that is in effect at the time the services are
rendered;
4. understand that if we I I) provide false or misleading information to
Adoption Services, we (I) forfeit our (my) right to any refunds as
stated in the Adoption Services Fee and Service Schedule;
5. consent that Adoption services and Adoption Services staff be permitted
to obtain copies of, and examine all, our (my) psychological, medical,
legal and other records and to intervie'W' all professional and lay
persons who might provide information regarding these records or provide
information related to our (my) desire to adopt a child; we (I) \o/ill
sign a release of information authorization form, as requested;
6. understand that the information given to Adoption Services as part of
the Registration, Application, Ilome study processes and post-placement
visitations, may be contained in written and/or verbal reports prepared
by Adoption Services and given to necessary attorneys, courts, other
agencies or government authorities as may be required. Furthermore, we
(I) understand that any and all information and records related to the
adoption process may be admitted as courtroom evidence and that Adoption
Services may use any and all information as part of its preparation for
court.room testimony;
E;":l1ibi t, "1"
Page 1 of 6
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7. understand that we (I) mayor may not agree with part of, or all of, any
reports, statements, conclusions and recommendations made by Adoption
Services regarding our (my) desire and/or fitness to adopt a child;
however, we (I) hereby release Adoption SerJices and/or its staff from
any and all liability arising from information contained in their
reports and/or conclusions and/or recommendations;
8. understand that a Home Study and/or Pre-placement Report completed by
Adoption Services does not in any way guarantee that a child referral
will be made by Adoption Services or that the Adoption Services' Home
Study or Pre-Placemeilt Report will be accepted by other private agencies
and/or local courts; and
9. agree to keep Adoption Services informed of any material changes or
anticipated changes in our (my) health or family including separation,
marital changes, pregnancy, change of residence, change of employer and
change in family structure;
Additionally, if
Services in matching
adoption, we (I) state
we (I) have
us (me) with
that we (I):
requested
a US-born
the assistance of Adoption
infant/child available for
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10. understand that in all domestic (US) adoptions at least three post-
placement visitations are required by Adoption Services and/or by state
law/regulations. Should we (I) not comply with this requirement, we (I)
understand that the placement of the child may be in jeopardy; however,
in such instances, we (I) release Adoption Services from any and all
liability therefrom.
11.
understand that in cases involving the placement of a child, such
placement will likely take place prior to the termination or
relinquishment of the biological parents' rights. In such instances, we
(I) recognize that, prior to the tellmination or relinquishment of
parental rights, either biological parent may change their mind
regarding the adoption process and may request the return of the child.
We (I) also recognize that the request for return, and return, of the
child could result in emotional turmoil and financia.l loss to us (me),
including the loss of Adoption Services' travel fees, the birthparents'
and. agency's a.ttorneys fees and birthmother and baby hospital/medical
related costs. In such an instance, we (I) release Adoption Services
from any and all liability therefrom. Furthermore, in such an instance,
we (I) agree to deliver the child to the Adoption Services' office on
the date and time requested by Adoption Services. In the event that ~Ie
(I) fail to comply with the demand to return the child, we-II) authorize
the agency to disclose our (my) identity to the natural parents and to
any and all other persons as deemed necessary by the agency to permit
the birthparents to pursue the return of their child. Additionally, we
(I) agree to pay for any and all time and legal fees incurred by
Adoption Services to enforce the above;
Page 2 of 6
,
12. understand that Adoption Services asks that each birthmother and, when
possible, each birthfather complete a Birthparent Health and Genetic
History Information Form. TI\e birthmother is also asked to sign a
release form allowing medical information and hospital records to be
released to Adoption Services and/or its attorney. We (I) understand
that we (I) will be given copies of the Birthparent Health and Genetic
History Information Form with the identifying information removed. We
(I) understand, and fully acknowledge, that the medical information
given to Adoption Services and passed onto us (me) may be incomplete or,
at times, misrepresented by the birthparents. We (I) understand that
Adoption Services does not make an independent investigation into the
birthparents' background other than to determine their intentions and
family history through interviews and conversations. Therefore, we (I)
understand Adoption Services cannot represent any and all of the risks
for the child' s health which may materialize in the present and/or
future. Accordingly, we (I) hereby release Adoption Services and/or its
staff from any and all liability arising from information, lack of
information or misinformation contained in information given to us (me)
about the backgrounds and medical conditions of the birthrnother,
birthfather, their families and the child;
13. acknowledge and agree that Adoption services cannot predict an
adoptive child's future including, but not limited to, emotional
and/or personality characteristics, health, medical problems,
learning disabilities, intellectual ability, hyperactivity,
attention deficits, appearance or inherited characteristics. We
(I) further .acknowledge that information provided by, and through,
the Agency may be incorrect because any medical and social history
and other information obtained by the Agency has been provided by
birthparents and/or by various other sources;
14. understand that, at the time we take custody of a child, we must escrow
anticipated birthrnother and child medical fees. These moneys will be
escrowed with the agency's attorney. We (I) understand and agree that
all medical bills be paid prior to the time of the final adoption
hearing. Accordingly, we (I) agree that any medical bills/charges
outstanding just before the final adoption hearing will be paid from our
escrow account. We (I) can then, on our (my) own, continue to resolve
any insurance reimbursement, although we (I) understand that insurance
reimbursement may not take place;
15. understand that there may be occasion when all medical bills are not
known or presented to us (me) at the time of placement or even at the
time of finalization. Because of unforeseen circumstances, including
insurance reimbursement requirements, any medical bills presented to us
(me), even after the placement and adoption are completed, will remain
our responsibility and we (I) agree to pay any such medical bills within
30 days of receipt of the bill(s);
16.
agree to give Adoption Services the right to remove and/or
removal of the child from our fa~mily and terminate
relationship with us (me) should, prior to finalization of
Buch action be deemed necessary by Adoption Services;
recommend the
the child's
the adoption,
Page 3 of 6
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17. agree to provide Adoption Services with pictures of, and updates on, the
child we (I) adopt. These pictures (at least twelve each time) will be
provided at a minimum of three-month intervals for the first year after
placement and at a minimum of twice per year (in December and May) for
the next four (4) years. All pictures are to be in focus with the
chilp.' s features clearly visible. The pictures will be of the same
quality as those normally included in my/our family picture album. The
updates are to be at least one page in length (approximately 250-300
word minimum) and should be of a quality you would send to a close
relative. Additionally, unless this sentence has been crossed out and
initialed, we (I) agree to provide a. "school picture" and update in
December of each year, covering ages 5 through 18. Each time pictures
are sent, we (I) agree to provide to Adoption Services a written update
regarding the child and his/her development. We (I) understand that
these pictures and written updates may be transmitted to the
birthparent(s). We (I) understand and agree that this Contract,
including this section, shall survive the final adoption of a child by
us (me) and shall not be terminated by an adoption decree;
18. understand that. by accepting pl~sical custody of a child placed with us
(me), we (I) agree to, and shall, provide all necessary care of the
child until the placement is terminated or concludes in adoption.
Should the placement be terminated for any reason, we (I) release
Adoption Services from any and all liability therefrom;
19. understand that confidentiality is important to birthparents and t.o
adoptive families. While Adopti.on Services will take precautions to
protect our (my) identity and that of the birthparents, by our (my)
design, the birthparent's design or by some possible error on the part
of Adoption Services, the hospital or attorneys involved, our (my)
identity and that of the birthparents could be divulged. If such
happens, we (I) release Adoption Services from any and all liability
therefrom. Additionally, \~e (I) understand that, in some instances,
adoptive parents who prefer anonymity may be confronted with
birthparents who, subsequent to placement, but prior to termination or
relinquishment, request a meeting with, or other identifying information
of, the adopting family. In such situations, we (I) agree to either
cooperate with the birthparents' request or, if so requested by the
birthparents, we (I) will return the child to Adoption Services;
20. understand and agree that should we (I) violate any of the above
Contract, we (I) agree to pay any and all legal fees incurred by
Adoption Services to enforce the above and we (I) agree to pay Adoption
Services' cun'ent hourly rate for any and all time expended by Adoption
Services' staff regarding this violation;
21. understand that we (I) must comply with all of the above sections as a
condition of the agency's Consent to the adoption;
22. understand and agree that this Contract shall survive the final adoption
of a child by us (me) and shall not be terminated by any adoption
dccrec.
Pagc 4 of 6
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Additionally, if we (I) have requested the assistance of Adoption
Services in matching us (me) with a Chinese-born, Moldova-born,
Pridnestrovie-bo.t:n or Russian-born infant/child available for adoption, we
(I) state that we (I):
23. acknowledge that the various Coordinators and Governmental agencies
in the foreign country to whom we are referred are not employees of
Adoption Services and, therefore, the Agency is not responsible. in
any fashion or manner for their actions;
24. acknowledge and understand that any fees charged in, and/or by, the
foreign country, such as the donations to the Orphanage, child's
visa, etc., are to be paid by us (me). Additionally, travel, food
and lodging are the Adoptive Parent's sole responsibility;
25. understand and agree that no portion of fees paid to Adoption
Services are f9r legal services and/or costs in obtaining a US
birth certificate, registering the adoption in a state court and/or
obtaining United States Citizenship;
26. acknowledge, understanri and agree that Adoption Services is not
responsible for any foreign fees, expenses, travel expenses and/or
cost of any kind or nature that we (I) incur in the event that an
adoption is not completed;
27. understand and agree that in the event that after placement, but
before finalization, a condition develops or is made known to us
(me) which causes us (me) to end the placement, we (I) understand
that no portion of the fees we (I) have paid will be refunded and
that Adoption Services shall not be responsible to us (me) for any
damages relating to the placementj
28. acknowledge that Adoption Services is not responsible for our (my)
safety and/or safety of the child at any time during the adoption
proceSSj
29. understand that the results of any medical tests and exams for the
child will be given to us (me). but understand and agree that the
Agency does not guarantee the accuracy of these reports. vle (I)
accept such risks in accepting the placement of a child;
30. acknowledge and agree that Adoption Services cannot predict an
adoptive child's future including, but not limited to, emotional
and/or personality characteristics, health, medical problern~,
learning disabilities, intellectual ability, hyperactivity,
attention deficits, appearance or inherited characteristics. We
(I) further acknowledge that information provided by, and through,
the Agency may be incorrect because any medical and social history
and other information obtained by the Agency has been provided by
the birthparents and/or by various other sourcesj <
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Page 5 of 6
31. understand that by accepting physical custody of a child placed
with us (me), we (I) agree to, and shall, provide all necessary
care of the child until the placement is terminated or concludes in
adoption. Should the placement be terminated for any reason, we
(I) release Adoption Services from any and all liability therefrom;
32. understand and acknowledge that if a condition arises after the
finalization of the adoption, the child is ours (mine) and cannot
be returned to Adoption Services and/or the authorities from the
foreign country from which the child .was' adopted. We (I) accept
such risk and agree that Adoption Services shall not be responsible
to us (me) or to our (my) child for any damages relating to any
condition;
33. understand and accept all the risks involved and we (I) will accept
our (my) adoptive child and hold the Agency, its Directors,
facilitators, officers and employees harmless. and release said
Agency from any claims or liability;
34. agree that in. the event that we (I) file any claim or action
against Adoption Services, without regard to the results, we (I)
agree to pay Adoption Services all cost it incurs in defending our
(my) claim.
We (I), the undersigned, have read the above Contract and/or it has
been read to us (me) and we (I) understand and agree to all its provisions.
~D,~, '13~p fHb,
P ospective Adopting Parent
plt;)~2E
~~-<~;~p -'~~^f!f)H;?
Prospective Adopting Parent
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Page 6 of 6
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11/24/98 13:08
'B717 731 0157
,\DOPTI O~ srcs ' " S.\CKS.
~004
Adoption Services, Inc.
28 Central Blvd.
Camp Hill, P A 17011
~ti-3
Statement
c- DATE
j- - -
i 11/25/98
--- --- -
-,
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- - - -- ~- -- - -- --.- ~-
TO: !
Mo&Flankjenrinclll:ttc~ -- - -- --, ---
8105 B.a, lIiII Road
ca'Th"'~ __ ~ ~ __ __
--i
i
i
I
I
__I
- -T
J: "',~~~UE J AMOUNT ENe I
AMOUNT I BALANCE
__ _ .. _ __ ___.-J
! 0.00
I 975.00
I 0.00
1,350.00
, 1,755.00
]4,905.00
]6,105.00
16';05.00
]6,36\.00
975.00
-975.00
1,350.00
405.00
lJ,150JXl
1,200.00
200.00
56.00
---- -'--'--"-"'-- -- - _.
,
DATE I
.-....____. _ --I. _ _ _
]2131195 I Balane<: fo,ward
08/13197 INV *5604
08/13197 I PMT#1879
08115197 11NV H5610
08/15/97 INV *5611
08127/97 IINV H5632
11107/97 ! INV H5758
11108/97 INV H5760
11/14197 (NY #5768
TRANSACTION
! - CU-RR~NT--' "':30 DAYS PAst
, DUE
... -'- --..- ---~ -.'- - - - . -
,
-3'--60 DAYS PAST-' 619-0 OAYS-PAST~ -OV!:R 96bAYS- AMoUNT DUE ~
.:_ _DUF,-- ' DUE _._ _P~S-r..DjJE___,___ ____
0.00
u nil
0.00
00.1
1".361,(;/
SI6,16J 00
l...._
Exhibi t "2"
11/24/98
11/24198 13:117
13;117 ~711 731 11157
'B7li 7';n 01~7
. .
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) ,~ SA~RS.
@002
,\OOI'1'1ON SYCS
Adoption Services, Inc.
28 Central Blvd.
CurnpHiII,PA 17011
(4~1.h- t1 /
Statement
-DATE -I
--- -- --j
I 11/25/98 I
I____J
-TO:-- - - -- - - - --- --- ,
Rlauch'cttc, Maurice &. Frnnkie ---
8105 Bear Hill Road
Royse Ciry TX 75189
\' - AM9UNT DUE - i AMO~NT E.i'lC;--~
$95.00
-----[ ------------L.,- ---------
DATE TRANSACTION I AMOUNT 1 BALANCE
- -12/31/95- Illalanceforward -- -- - - .- -- - - i- - -- :---- - .- 0.00
05117/96 IINV #4889 - 475.00 I 475.00
05/17/96 I PMT #1303 -475.00 , 0.00
OGI12J'l6 INV #4933 . 5.00 I 5.00
06/13/96 I PMT #11727 -5.00 0.00
07110196 INV #4999 _ 20.50 II 20.50
07/10/96 INV #5002 _ 3,275.00 3,295.50
07/11/96 I PMT #1372 -3,295.50 0.00
08/02/96 I.INV #5057 _ 1,140.00 1,140.00
09/04/96 ! I'MT #1454 -1,140.00 0.00
10/02J'l6 INV #5170 _ 190.00 190.00
11/01196 INV #5215 _ 1,615.Q{) 1,805.00
01120/97 PMT #1636 -J,822.00 -17.00
04/02197 INV #5410/11 13.017.50 13,000.50
04102/!I7 \INV #5412 68.36 13.068.86
06i\J2/!I7 PMT #3297 -13,or,s.86 0.00
06106197 IINV #5483 95.00 95.00
I
I
I
I
I
I ,
i-CURRENT - - 1:35 DAYS PAST- 31:60 bAYS'PAsT '61-90 DAYS-PASTi-OVEIl-90DAYS-
DUE ' DUE ' DUE ,PAST DUE
-"--f -~- _. ..- -- - --',- - -- - - - - - -- -- -~ - -...-.
I__n_
-.'-- ----" -.;
,
AMOUNT DUE
..-.,
0.00
0.00
Mil
0.00
Q5 nn
~95.00
. -. j -
Ex11ibit "3"
11/24/98
13:07
'8'717 731 0157
,>; 5;\CI(5.
~003
" ,:" ' " ^' '." - '" '"I .", : _'. , . . '. '~. '. ' , '
.' . . . ,.,.' . . - , .
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Adoption Services, Inc.
28 Central Blvd.
Camp Hill, PA 17011
Statement
4~rf-J.
L ---I2.A~E _ I
I 11/25/98 J
----.--
1- TO: - ----- - - - -- --- -- - I
I~"""""''''''~..- - - -- -- -- ,
H 105 Ilear lIi11lto." I
Roy.. City TX 75189 :
I
L_ --__' _ _ __ __ ____ i
r. AMOUNT Due--l AMoUNT ENe. .-
1-- -SlOO.OO -- ,- - - _.
i=- DATE--~r_~ -~~ ~ TRANSA~TION -=- ~-~J1__ A~OUNT ~ _BALANC~'
1- 12131/95 i Balance forward -O:-oii
02124/97 I INV #5356 975.00 975.00
02124/97 PMT HI525 .975.00 0.00
03126/97 I (NV #5391 427.50 427.50
03/26/97 I INV #5392 1,235.00 1,662.50
03126/97 INV #5393 190.00 I,H52.50
03/26/97 INV #5394 190.00 2,042.50
04108/97 (NV H5422 6,295.00 8,337.50
07/31/97 PMT HI876 -8,337.50 0.00
07fl1/<;7 INV #5585 1,140.00 1,140.00
081051'l7 INV H5595 43.79 :,183.79
09/29/97 PM,. #1944 -1,183.79 0.00
10/02197 INV #5698 100.01l 101l.00
i CURI1ENT
1-.
I
;- '.30 bAYS pAST ~3-1 60 DAYSPASf'61.90DAY1) PASTr OVER 90 D/fvs
.J. _ .Dl!.,E., _ _D~!; _ _ __ DUE _P~ST_9.l!.,E
-'
~ --- -- --",- -~~
AMOUNT DUE !
_0" ____ ~
O.Ou
0.00
(1,00
Ol)()
lOG 00
$100.00
l__
Exhibit. "4"
12/01/9S 15:UI
'5'717 731 0157
,IIlOI'T1 O~ SI'CS
>,.. S.ICtiS.
~002
..
7(.11( '7{,
t ~ ~~B~~'!~~P~" P~'~~~)~~~~~X ~'~~'~O'"
pROSPECTIVE ADOPTING PARENTS CONTRACT
~
\'Ie (I),
parents and request
state that we (I):
the undersigned, are interested in becoming adoptive
the assistance of Adoption Services. Accordingly, we (I)
1. have read and understand the Adoption Services Program Description (Rev.
5/96) and Fee and Service Schedule (Rev, 7/96);
2. state that, with the exception of the information as specifically stated
in the Program Description and Fee and Service Schedule, no promises
and/or guarantees of any kind have been made or implied to us (me) by
Adoption Services or its staff;
3. understand that we (I) will be notified of any changes in the current
Fee and Service Schedule that will apply to us (me) and agree to pay
Adoption Services for services rendered in accordance with the Fee and
Service Schedule that is in effect at the time the services are
rendered;
4. understand that if we (I) provide false or misleading information to
Adoption Services, we (I) forfeit our (my) right to any refunds as
stated in the Adoption Services Fee and Service Schedule;
5. consent that Adoption Services and Adoption Services staff be permitted
to obtain copies of, and examine all, our (my) psychological, medical,
legal and other records and to interview all professional and lay
persons ,~hc r::ight p."o'.'ide infonr,ation regarding these records or provide
information related to our (my) desire to adopt a child; we (I) will
sign a release of information authorization form, as requested;
6. understand that the info1:lnation given to Adoption Services as part of
the Registration, Application, Home Study processes and post-placement
visitations, may be contained in written and/or verbal reports prepared
by Adoption Services and given to necessary attornp.ys, courts, other
agencies or government authorities as may be required. Furthermore, we
(I) under>ltand that ,3ny and all information and records related to the
adoption process may be a.dmitted "s courtroom evidence and that Adoption
Services may use any and all information as part of its preparation for
courtroom testimony;
F:~hi bi t "5'1
Pag" 1 of 6
12/01/98 15:01
'B717 731 01..~Z
,\\l0l'f1 ON 5\'c'S
. .:' SACK~
~003
7. understand that we (I) mayor may not agree with part of, or all of, any
reports, statements, conclusions and reconunendations made by lIdoption
services regarding our (my) desire and/or fitness to adopt a. child;
hO\~evcr, we (I) hereby release Adoption Service:; and/or its :;taff from
any and all liability arising from information contained in their
reports and/or conclusions and/or recommendations;
8. understand that a Home Study and/or Pre-placement Report compteted by
Adoption Services does not in any way guarantee that a child referral
will be made by Adoption Services or that the Adoption Services' Home
Study or Pre-Placement Report will be accepted by other private agencies
and/or local courts; and
9. agree to keep Adoption Services informed of any material changes or
anticipated changes in our (my) health or family including separation,
marital changes, pregnancy, change of residence, change of employer and
change in fami.ly structure;
Additionally, ~I
Services in matching
adoption, we (I) state
we (I) have
us (me) with
that we (1):
requested
a US-born
the assistance of Adoption
infant/child available for
10. understand that in all dome:;tic (US) adoptions at least three post-
placement visitations arc required by Adoption Services and/or by state
Law/regulations. Should we (I) not comply with this requirement, we (I)
underst.and that the placement of the child !nay be in jeopardy; however,
in such instances, we (I) rel ease Adoption Services from any and all
liability therefrom.
11. understand that in cases involving the placement of a child, such
placement will likely take place prior to the termination or
relinquishment of the biological parents' rights. In such instances, we
(I) recognize that, prior to the termination or relinquishment of
parental rights, either biological parent may change their mind
regarding the adoption process and may request the return of the child.
We (I) also recegnize that the request for return, and return, of the
child could result in emotional turmoil and financial loss to us (me),
including the loss of Adoption Services' travel fees, the hi.rthp.:Jrents'
and agency' s attorneys fees and birthmother and baby hospi.tal/medical
related costs. In such nn instance, we (r) re lease Adoption Services
from any and all liability therefrom. Furthermor", in such an instance,
we (I) agree to deliver the child to the Adcption Services' office on
the date and time requested by Adoption Services. In the event that we
(I) fail to comply with the demand to return the child, \<,'e (I) authorhe
the agency to disclose our (my) identity to the natural parents and to
any and all other. pE:'rsolls ''is deemed neceSS<:lry by t.he agency to permit
the birthparcnts to pursue the return of th"ir child. Additionally, we
(I) agree to pay for any and all time and leg"} fees incurred by
Adoption Services to enforce the above;
Page 2 of G
12/01/P8 15:02
5\'C5
-+.........
. ..
. ' . , " . '>. .' ' \ O' . " '- .' , , , ,.' ,',
12. understand that Adoption Servi.ces asks that each birtlunother and, when
possible, each birthfather complete a Birthparent Uealth and Genetic
Uistory Information Form. 'rhe birthmother is also .asked to sign a
release form al.lowing medical information and hospital records to be
released to Adoption Sc.rvices and/or its attorney. We (I) understand
that we (I) will be given copies of the Birthparent Health and Genetic
History Information Form with the identifying information remov~d. We
(I) understand, and fully acknowledge, that the medical information
given to Adoption Services and passed onto us (me) may be incomplete or,
at times, misrepresented by the birthparents. We (I) understand that
Adoption Services does not make an independent investigation into the
birthparents' background other than to determine their intentions and
f~nily history through interviews and conversations. Therefore, we (I)
understand Adoption Services cannot represent any and all of the risks
for the child's health which may materialize in the present and/or
future. Accordingly, we (I) hereby release Adoption Services and/or its
staff from any and all liability arising from information, lack of
information or misinformation contained in information given to us (me)
about the backgrounds and medical conditions of the birthmother,
birthfather, their families and the child;
13. acknowledge and agree that Adoption Services cannot predict an
adoptive child' 5 future including, but not limited to, emotional
and/or personality characteristics, health, medical problems,
learning disabilities, intellectual ability, hyperactivity,
attention deficits, appearance or inherited characteristics. We
(I) further acknowledge that information provided by, and through,
the Agency may be incorrect because any medical and social history
and other information obtained by the Agency has been provided by
birthparents and/or by various other sources;
14. understand that there may be occasion when all medical bills are not
known or presented to us (me) at the time of placement. Because of
unforseen circumstances, including insurance reimbursement requirements,
any medical bills presented to us (me), even after the placement and
adoption are completed, will remain our responsibility;
15.
agree to give Adoption Services the right to remove and/or
removal of the child from our family and terminate
relationship with us (me) should, prior to finalization of
such action be deemed necessary by Adoption Services;
16. agree to provide Adoption Services with pictures of, and updates on, the
child we (I) adopt. These pictures (at least six each time) will be
provided at a minimum of three-month intervals for the first year after
placement and at a minimum of twice per year (in Dccember and May) for
the next fnur (4) years. Additionally, unless this sentence has been
crossed out and initialed, we (I) agree to pl:.ovide a "school picture"
and update in December of each year, covering ages 5 through 18. Each
time pictures are sent, we (I) agree to provide to Adoption Services a
written updatc regarding the child and hi.s/her development. We (I)
understand that these pictures and written updates may be transmitted to
the birthparent(s). We (I) understand and agree that this Contract,
including this section, shall survive the final adoption of a child by
us (me) and shalJ not he termi.nated by an adoption decree;
recommend the
the child's
the adoption,
Page 3 of G
,~ ,"-
~~"........
...
----. - -- _. -- - .,"-"-
17.
understand that by accepting physical custody of a child placed with us
(me), we (I) agree te" and shall, provide all necessary care of the
child until the placement is terminated or concludes in adoption.
Should the placement be terminated for any reason, we (I.) release
Adoption Services from any and all liability therefrom;
understand that confidentiality is important to birthparents and to
'. '.
adoptive families. While Adoption Serv:LCCs w:Lll take precaut:Cons to
protect our (my) identity and that of the birthparents, by our (my)
design, the birthparent's design or by some possible error on the part
of Adoption Services, the hospi.tal or attorneys involved, our (my)
identity and that of the birthparents could be divulged. If such
happens, we (I) release Adoption Services from any and all liabil ity
therefrom. Additionally, we (I) understand that, in some instances,
adoptive parents who prefer anonymity may be confronted with
birthparents who, subsequent to placement, but prior to terminati.on or
relinquishment, request a meeting with, or other identifying information
of, the adopting family. In such situations, we (I) agree to either
cooperate with the birthparents' request or, if so requested by the
birthparents,. we (I) will return the child to Adoption Services;
understand and agree that should we (I) violate any of the above
Contract, we (I) agree to pay any and all legal fees incurred by
Adoption Services to enforce the above and we (I) agree to pay Adoption
Services' current hourly rate for any and all tilne expended by Adoption
Services' staff regarding this violation;
18.
19,
20.
understand that We (I) must comply with all of the above sections as a
condition of the agency's Consent to the adoption;
understand and agree that this Contract shall survive the final adoption
of a child by Us (me) and shall not be terminated by any adoption
decree.
21.
Additionally, if We (I) have requested the assistance of Adoption
Services in matching. us (mf2) with a Chinese-born infant/child available for
adoption, we (I) state that \012 (I):
22. acknowledge that the various Governmental agencies in China to whom
we are referred are not employees of Adoption Services and,
therefore, the Agency is not responsible in any fashion or manner
for their actions;
23. acknowledge and ullderGtand that any fees charged in the Peoples'
Republic of China, such as the donations to the Orphanage, child's
visa, etc., are to be paid .by us (me). Additionally, travel, food
and lodging are the Adoptive Parent's sole responsibility;
24. understand and agree th.at no portion of fees paid to Adoption
ServiCf2s are for 1ll9".l services .lnd/or costs in obtaining a US
birth certificate, rf2gistering the adoption in " stat.e court and/or
obtai,ning United States Ci.ti~en:.;hi.p;
P"'Je 4 CJf 6
.
.... -'''~
.' .,' ". - " . ' ," ".
'.":".
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15: (l.t
'B717 73\ 0157
.' S'TS ...~~ SACK:;
~~IJOI:LlO,' . ~ _ _ _.._
~O(l6
25. acknowledge, understand and agree that Adoption Services is not
responsible for any foreign fees, expenses, travel expenses and/or
cost of any kind or nature that We (I) incur in the event that an
adoption is not. completed;
26. understand and agree that in the event that after placement, but
before finalization, a condition develops or is made known to ,us
(me) which causes us (me) to end the placement, we (I) understand
that no portion of the fees we (I) have paid will be refunded and
that Adoption Services shall not be responsible to us (me) for any
damages relating to the placement;
27. acknowledge that Adoption Services is not responsible for our (my)
safety and/or safety of the child at any time during the adoption
process;
28. understand that the results of any medical tests and exams for the
child will be given to us (me) but understand and agree that the
Agency does not guarantee the accuracy of these reports. We (I)
accept such risks in accepting the placement of a child;
29. acknowledge and agree that Adoption Services cannot predict an
adoptive child's future including, but not limited to, emotional
and/or personality characteristics, health, medical problems,
learning disabilities, intellectual ability, hyperactivity,
attention deficits, appearance or inherited characteristics. w~
(I) further acknowledge that information provided by, and through,
the Agency may be incorrect because any medical and social history
and other information obtained by the Agency has been provided by
the birthparents and/or by various other sources;
30. understand that by accepting physical custody of a chi ld placed
with us (me), we (I) agree to, and shall, provide all necessary
care of the child until the placement is terminated or concludes in
adoption. Should the placement be terminated for any reason, we
(I) release Adoption Services from any and all liability therefrom;
.
31.'
understand and
finalization of
be returned to
(I) accept such
responsible to
relating to any
acknowledge that if a condition arises after the
the adoption, the child is ours (mine) and cannot
Adoption Services and/or Chinese authorities. We
risk and agree that Adoption Services Bhall not be
us (me) or to our (my) child for any damages
condition;
32. understand and accept all the risks involved and we (I) will accept
our (my) adoptive child and hold the Agency, its Directors,
facilitators, officers and employees harmless and release said
Agency from any claims or liability;
33. agree that in the event that we (I) file any claim or action
against Adoption Services, "ithout regard to the resultOJ, we (:r.)
agree to pay Adoption Services all cost it incurs in defending our
(my) claim.
Page 5 of 6
":, '.. .. ,/ .,.,.. ,.'. .,', .,.. .". ,.. ':' "..'..1 ,: ... ...
. ., " '" .... J~ ". _' , . . .
. '''. . . , " . '
. . .
-_.~-
12/lJI/98
15:05
'B71i 731 niSi
.\/'2I'E I (~, .~CS
i ) ~ S;\CK~
~lJlJi
"- _. ._- _u.._
-- ---.....- -
We (I), the undersigned, have read the above Contract and/or it has been
read to us (me) and we (Il understand and agree to all its provisions.
..7J / ( ..'-J.' ,., /1
.~. J 'j
, l ../- ..;
\i l( ,I.e.!. c{.{ -' t~j~(( /:1. / %>.li{!:;;
rospective Adopting Parent
'?!Ji/f:/
. D E ~
,
-2(
.- 9(:
/ DATE
Rev. 7/96
Page 6 of 6
- . .
' . \.' ' " ' , " '," . , . \ '" ' ,.; '. ~ - , . "" . ~ ,)'.. .', .
. " -
12/01/98 15:05
'5'7\7 73\ U157
1 I' S;\Cf\~:.
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.' ".' , '. . - . ' ,
.\llIJI'T\lI~ sn:s
c ~ ~~~~'!~~P~,. P~7~~~)~~~~~X~7~~~"57
PROSPECTIVE ADOPTING PARENTS CONTRACT
~
We (I),
parents and r.equest
state that we (I):
the undersigned, are interested in becoming adoptive
the assistance of Adoption Services. Accordingly, we (1)
1. have read and understand the Adoption Servicen Program Description {Rev.
S/96l and Fee and Service Schedule (Rev. 7/96);
2. state that, with the exception of the information as specifically stated
in the Program Description and Fee and Service Schedule, no promises
and/or guarantees of any kind have been made or implied to us (me) by
Adoption Services or its staff;
3. understand that we (I) will be notified of any changes in the current
Fee and Service Schedule that will apply to Us (me) and agree to pay
Adoption Services for services rendered in accordance with the Fee and
Service Schedule that is in effect at the time the services are
rendered;
4. understand that if we (I) provide false or misleading information to
Adoption Services, we (I) forfeit our (my) right to any refunds as
stated in the Adoption Services Fee and Service Schedule;
5. consent that Adoption Services and Adoption Services staff be permitted
to obtain copies of, and examine all, our (my) psychological, medical,
legal and other records and to interview all professional and lay
persons who might provide information regarding these records or provide
information related to ou.r (my) desire to adopt a child; we (I) will
sign a release of information authorization form, as requested;
6. understand that the infonnation given to Adoption Services as part of
the Registration, Application, Home Study processes and post-placement
visitations, may be contained in written and/or verbal reports prepared
by Adopt.ion Services and given to necessary attorneys, courtn, other
agencies or goverlUnent authorities as may be required. Furthermore, we
(I) understand that any and all information and records related to the
adoption process may be admitted as courtroom evidence and that Adoption
Services may use any and all information as part of its preparation for
courtroom testimony;
Exhibi t '10"
Page 1 of 6
12101/98
'3'717 731 0157
~1I119
" ". "'. " -~' "'.. .' . ..'"" '." ^ ' , '.. ,. I , .
15:01)
, .
AIJIII'TIO'\ ~.YCS..
. I. S:\~~~;
7. underatand that we (1) mayor may not agr.ee with part of, or all of, any
reports, statement", concluoions and recommendations made by Adoption
ServiGes regarding our (my) desire and/or fitness to adopt a child;
however, WP. (I) hereby release Adopti on Servtc.es and/or its staff from
any and all liability arisi.ng from information cont",ined in thei.r
reports and/or conclusions and/or recommendations;
8. understand that a Home Study and/or Pre-placement Report compLeted by
Adoption Services does not in any way guarantee that a child referral
will be made by Adoption Services or that the Adoption Services' Home
Study or Pre-Placement Report will be accepted by other private agencies
and/or local courts; and
9. agree to keep Adoption Services informed of any material changes or
anticipated changcs in our (my) health or family including separation,
marital changes, pregnancy, change of residence, change of employer and
change in family structure;
Additionally, if we (I) have
Services in matchillg us (me) with
adoption, we (I) ~tate that We (I):
10. understand that in all domestic (US) adoptions at least three post-
placement visitations are required by Adoption Services and/or by state
law/regulations. Should we (I) not comply with thi~ requirement, we (I)
understand that the placement of the child may be in jeopardy; however,
in such instances, we (I) release Adoption Services from any and all
liability therefrom.
requested the assistance of Adoption
a US-born infant/child available for
11. understand that in cases inVOlVing the placement of a child, such
placement will likely take place prior to the termination or
relinquislunent of the biological parents' rights. In such instances, we
(I) recognize that, prior to the termination or relinguislunent of
parental rights, either biological parent may change their mind
regarding the adoption process and may request the return of the child.
We (I) also recognize that the request for return, and return, of the
child could result in emotional turmoil and financial loss to us (me),
includi.ng the loss of ./l.doption Services' travel fees, the birthparents'
and agency' s attorneys fees and birtlunother and baby hospital/medical
related costs. In such an instance, ''''e (I) relAase Adoption Services
from any and all liability therefrom. Furthermore, in such an instance,
we (I) agree to deliver the child to the Adoption Services' office on
the date and time requested by Adoption Services. Tn the event that we
(I) fail to comply with the demand to return the child, we (I) authorize
the agency to diSClose our (my) identity to the natural parents and to
any and all other persons as deemcd necessary by the agency to permit
the hirthparents to pursue the return of their child. Additionally, ~e
(I) agree to pay for any and all time and legal fees incurred by
Adoption Services to enforce the above;
Page 2 of 6
. .'
12/()1/9S ~5;1)7
'aili i.lI (1157
",Il{)J:LIO~ SI'CS
) I ~ S.ICK9;
_...-- .
~010
12. understand that Adoption Services asks that each birthmother and, when
possible, each birthfather complete a Birthparent Health and Genetic
History Information Form. 'l'he birthmother is also asked to sign a
release form allowing medical information and hospital records to be
released to Adoption Services and/or its attorney. We (I) understand
that we (I) will be given copies of the Birthparent Health and Genetic
History Information Form with the identifying information removed. We
(I) understand, and fully acknowledge, that the medical information
given to Adoption Services and passed onto us (me) may be incomplete or,
at times, misrepresented by the birthparents. We (I) understand that
Adoption Services does not make an independent investigation into the
birthparents' background other than to determine their intentions and
family history through interviews and conversations. Thercfore, we (I)
understand Adoption Services cannot represent any and all of the risks
for the child' 13 health which may materialize in the present and/or
future. Accordingly, we (I) hereby release Adoption Services and/or its
staff from any and all liability arising from information, lack of
information or misinformation contained in information given to us (me)
about the backgrounds and medical conditions of the birthmother,
birthfather, their families and the child;
13. acknowledge and agree that Adoption Services cannot predict an
adoptive child' s future including, but not limited to, emotional
and/or personality characteristics, health, medical problems,
learning disabilities, intellectual ability, hyperactivity,
attention deficits, appearance or inherited characteristics. We
(I) further acknowledge that information provided by, and through,
the Agency may be incorrect becausc any medical and social history
and other information obtained by the Agency has been provided by
birthparents and/or by various other sources;
14. understand that there may be occasion when all medical. bills are not
known or presented to us (me) at the time of placement. Because of
unforseen circumstances, including insurance reimbursement requirements,
any medical bills presented to us (me), even after the placement and
adoption are completed, will remain our responsibility;
.
15 ..
agree to give Adoption Services the right to remove and/or
removal of the child from our family and terminate
relationship with us (me) should, prior to finalization of
such action be deemed necessary by Adoption Services;
recommend the
the child' s
the adoption,
16. agree to provide Adoption Services with pictures of, and updates on, the
child We (I) adopt. These pictures (.,t least six each time) will be
provided at a rninimwn of three-month intervals for the first year after
placement and at a minimum of twice per year (in December and May) for
the next fOllr (4) years. Additionally, unless this sentence has been
crosGed out and initialed, we (I) agree to provide a "school picture"
and update in December of each year, covering ages 5 through 18. Each
time pictures are sent, "'e (I) agree to provide to Adoption Services a
",ritten update regarding the child and his/her development. We (I)
underG,tand that these pictures and ",ritten updates may be transmitted to
the bl.rthparent(s). We (I) understand and agree that this Contract,
including t.his section, shall survive the final adopt.ion of a child by
us (me) and shall not be terminated by nn adoption decree;
Page 3 of 6
IVOI/OS .15:0,S
'3'717 7:11 0157
,1IH1PTIO~ sn:s _ " SSK~:.
~Oll
.: ..:., ;..'--". ."'.,.. ,.~ .,. ," .'. ~ :.. ..':,-' ." '..',":'. . .'. ..:... .'. ,.
. .
17. understand that by accepting physical custody of d child placed with us
(me), we (I) ilgree to, and shilll, provide all necessary care of the
child until the placement is tenninated or concl udeB in adoption.
Should the plilCelnent be terminated for any reason, We (I) release
Adoption Service" from any and all liability ther.efrom;
18. understand that confidentiality is important to birthparents and to
adoptive families. While Adoption Services will t.ake precaut<ions to
protect oUr (my) identity and that of the birthparents, by our (my)
design, the birthparent' s design or by some possible error on the part
of Adoption Services, the hospital or attorneys involved, our (my)
identity and that of the birthparents could be divulged. If such
happens, We (I) release Adoption Services from any and all liability
therefrom. Additionally, we (I) understand that, in some instances,
adoptive parents who prefer anonymity may be confronted with
birthparents who, subsequent to placement, but prior to termination or
relinquishment, request a meeting with, or other identifying information
of, the adopting family. In such situations, we (I) agree to either
Cooperate with the birthparents' request or., if so requested by the
birthparents, we (I) will return the child to Adoption Services;
19. understand and agree that should we (I) violate any of the above
Contract, we (I) agree to pay any and all legal fees incurred by
Adoption Services to enforce the above and we (I) agree to pay Adoption
Services' current hourly rate for any and all time expended by Adoption
Services' staff regarding this violation;
20. understand that we (I) must comply with all of the above sections as a
condition of: the agency's Consent to the adoption;
21. understand and agree that this Contract shall survive the final 'adoption
of a child by Us (me) and shall not be terminated by any adoption
decree.
Additionally, if we (I) ha\'e reqnested the asnistance of Adoption
Services in matching. us (me) with a Chinese-bo!:n infant/child available for
adoption, we (I) state that we (I):
22. acknowledge that the vari.ous Governmp.ntal agencies in China to whom
We are refp.rred are not employees of Adoption Services and,
therefore, the Agency is not responsi.ble in any fanhion or manner
for their actions; .
23. acknowledge and understand that any fees charged in the Peoples'
Republic of China, such as the donati.ons to the Orphanage, child's
visa, etc., are to be pai.d by us (me). Additionally, travel, food
and lodging are the Adoptive Parent's sole responsibility;
24. understand .:lnd agree tllat no porti.on of f""s paid to Adoption
Services are for legal services and/or costs in Obtaining n US,
birth certifiGote, registering the adoption in a state court and/or
obta~ning United Statel; Citizenc'hip;
Pa<Jp 4 of 6
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12/01/US 15;U,9
'Bi17 i31 Ola7
, I" S:!.r.'^~'
~012
ADOPT 11I~.."~,y~S
25. acknowledge, understand and agI:cc that Adoption Services is not
responsi.ble for any foroign fees, expenses, travel expenses and/or
cost of any kind or nature that we (1) incur in the event that an
adoption is not completed;
26. understand and agrp.e that in the event that after placement, but
before finalization, a condition develops or is madp. known to ~us
(me) which causes us (me) to end the placement, we (I) understand
that no portion of the fees we (I) have paid will be refunded and
that Adoption Services shall not be responsible to us (me) for any
damages relating to the placement;
27. acknowledge that Adoption Services is not r~sponsible for our (my)
safety and/or safety of the child at any time during the adoption
process;
20. understand that the results of any medical tests and exams for the
child will be given to us (:ne) but understand and agree that the
Agency does not guarantee the accuracy of these reports. We (I)
accept such risks in accepting the placement of a child;
29. acknowledge and agree that Adoption Services cannot predict an
adoptive child's future including, but not limited to, emotional
and/or personality characteristics, health, medical problems,
learning disabilities, intellectual ability, hyperactivity,
attention deficits, appearance or inherited characteristics. We
(I) further acknowledge that information provided by, and through,
the Agency may be incorrect because any medical and social history
and other information obtained by the Agency has b"en provided by
the birthparents and/or by various other sources;
30. understand that by accepting physical custody of a child placed
with us (me), we (I) agree to, and shall, provide all necessary
care of the child until the placement is tenninated or concludes i.n
adoption. Should the placement be tenninated fOI: any reason, we
(I) release Adoption Services from any and all liability therefrom;
31. understand and acknowledge that if a condition arises after the
finalization of the adoption, the child is ours (mine) and cannot
be returned to Adoption Services and/or Chinese authorities. We
(I) accept such risk and agree that Adoption Services shall not be
responsible to us (me) or to our (my) child for any damages
relating to any condition;
32. understand and accept all the risks involved and we (I) will accept
our (my) adoptive child and hold the Agency, its Directors,
facilitators, officer" and employees harmless and release said
Agency from any claims or liability;
33. agree that in the event that we (I) file any claim or action
against Adoption Services, without regard to the rC5ults, we (I)
agree to pay Adoption Services all cost it incurs in defending our
(my) claim.
Page 5 of 6
---- -. --~...."
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ADOPTION SERVICES, INC.,
Plaintiff
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
v.
NO. 9:/~ ')OJ'I (;JJ'T'_/ 7::~-~__
MAURICE G. 8LANCHETTE and
FRANKIE SUE BLANCHETTE,
husband and wife,
Defendants
CIVIL ACTION - IN EQUITY
AFFIDAVIT
On December 21, 1998, the undersigned caused to be mailed a true
and correct copy of the Complaint filed in this matter to the Hunt
County Sheriff's office for service upon Maurice G. Blanchette and
Frankie S. Blanchette. Attached to this Affidavit and marked as
Exhibit "1" is the Affidavit of Service from the Hunt County Sheriff
acknowledging that Maurice G. Blanchette was served with the Complaint
on December 28, 1998.
On January 19, 1999, the undersigned caused to be mailed an
additional true and correct copy of the Complaint filed in this matter
to the Hunt County Sheriff's office for service upon Frankie S.
Blanchette. Attached to this Affidavit and marked as Exhibit "2" is
the Affidavit of Service from the Hunt County Sheriff acknowledging
that Frankie S. Blanchette was served with the Complaint on January
25,1999.
I verify that the statements made in this Affidavit are true and
correct. I understand that false statements herein are made subject
to the penalties of 18 Pa.C.S.A. 34904 relating to unsworn
falsification to authorities.
Date: March 25, 1999
..... .--'. .
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Esquire
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Stuart S. Sacks,
I.D. No. 18059
Smigel, Anderson & Sacks
2917 North Front Street
Harrisburg, PA 17110-1223
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HU~JT COUNTY SHERIFF
CRIMINAL JUS1ICE CENl ER
903/455.3502
FAX 903/454.3447
. Al'FI!lAVlT OF SERVICE
DON ANDERSON, Sheriff
2700 JOHNSON STREET
GREENVILI.E, TEXAS 75401
STATE OF TEXAS
COUNTY OF HUNT
CAME TO HAND ON THE
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(9PH. CAUSE No._<1_2~AND EXECUTED AT ~ 700 ..::rohtJ 511,,) SJ.
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1'00
^ TRUE COPY OF A CITATION.
I AM NOT A E,dY TO OR INTERESTED IN THE OUTCO:-!E OF THE SurT REFERENCED ABOVE.
STATE OF TEXAS
COUNTY OF HUNT
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BEFORE ;!E A NOTARY Pl1BLIC, ON TillS DAY PERSON/,LLY APPEARE0h,o \ T(J{.l,l<__
KNO\<'N TO HE TO BE THE PERSON I<'llOSE NA.'lE IS SUBSCRIBED TO TilE FOR, ,OING DOCUMENT AND,
BEINe; BY ~\E FIRST DULY SI<'ORN, DECLARED THAT TilE STATE!.:ENTS THERE IN CONTAINED ARE TRUE
AND CORRECT.
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CRIMINAL JUSTICE CENTER
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FAX 903/454.3447
DON ANDERSON. Sher.ff
2700 JOHNSON STREET
GREENVILLE. 'fEXAS 75401
AFFIDAVIT OF SERVICE
STATE OF TEXAS
COUNTY OF HUNT
;J~N~~J;,~,
1999 AT~:O C
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g 1(;\ Ncl'~.JRUE C~PY
OF A CITATION.
I ~~ NOT A PARTY TO OR INTERESTED IN THE OUTCO}X OF THE SUIT REFERENCED ABOVE.
"Y /lf~/ ~ I
STATE OF TEXAS
COUNTY OPO HUNT
BEFORE ME A NOTARY PUBLIC, ON THIS DAY PERSONALLY APPEARE~~1r\~
KNovm TO ME TO BE THE PERSON WHOSE N~"!E IS SUBSCRIBED TO TilE FOREr-OING DOCUMENT AND
BEING BY ME FIRST DULY SWORN, DECLARED TIlAT THE STATEMENTS THERE IN CONTAINED ARE TRUE
AND CORRECT. '--I
GIVEN UNDER BY !lAND AND SEAL OF /7 OF +9 b.lf91A.D.
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NOTARY PUBLIC. STATE OF
DON ANDERSON. Sheriff
2700 JOHNSON STREET
GREENVILLE, TEXAS 75401
,
Smigel, M1derson & Sacks
Attorneys At Law
2917 N. Front Street
Harrisburg,Pennsylvania
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CERTIFICATE OF SERVICE
\, C. Lee Andersoll, hereby certify that a true and correct copy of Plaintiffs Praecipe to
Enter Judgment by Default was served upon the following as addressed below by depositing the
same in the United States Mail, first class, postage prepaid, on March ..z 1/ , 1999:
Frankie Sue Blanchette
8105 Bear 1 Ii II Road
RoyseCity,TX 75189
Maurice G. Blanchette
8105 Bear Hill Road
Royse City, TX 75189
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C. Lee Anderson, Esquire
1.0.#: 21315
2917 North Front Street
Harrisburg,PA 17110
(717) 234-240 I
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4Ba~2.1/Notice/SSS/gcp 03/11/')9 JI29pnl
ADOPTION SERVICES, INC.,
plaintiff
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
NO. 98-7091 EQUITY TERM
_ ," -:~';:"":~:..i~1'''', :."<<0".,;.,, ru'~, 1'.").~'r;.,f-;;r-'~'':.'''~' ."",",;;':~;j~" J ~"~\' "-<r.t.~"~. _.""rr; ,.~ _',' ~_ ':,", , . ~
. .
v.
MAURICE G. BLANCHETTE and
FRANKIE SUE BLANCHETTE,
husband and wife,
Defendants
CIVIL ACTION - IN EQUITY
TO: MAu~ICE G. BLANCHETTE and FRANKIE SUE BLANCHETTE,
husband and wife
DATE OF NOTICE: March 11, 1999
IMPORTANT NOTICE
YOU ARE IN DEFAULT BECAUSE YOU HAVE FAILED TO ENTER A WRITTEN
APPEARANCE PERSONALLY OR BY ATTORNEY AND FILE IN WRITING WITH THE
COURT YOUR DEFENSES OR OBJECTIONS TO THE CLAIMS SET FORTH AGAINST YOU.
UNLESS YOU ACT WITHIN TEN DAYS FROM THE DATE OF THIS NOTICE, A
JUDGMENT MAY BE ENTERED AGAINST YOU WITHOUT A HEARING AND YOU MAY LOSE
YOUR PROPERTY OR OTHER IMPORTANT RIGHTS. YOU SHOULD TAKE THIS NOTICE
TO A LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR Ck~OT AFFORD
ONE, GO TO OR TELEPHONE THE FOLLOWING OFFICE TO FIND OUT WHERE YOU CAN
GET LEGAL HELP.
Cumberland County Bar Association
2 Liberty Avenue
Carlisle, PA 17013
(717) 249-3166
C_/7 c.::::?-
(.,~' 0 .)z~k~
stuartS. Sacks, Esq.
I.D. No. 18059
SMIGEl" ANDERSON & SACKS
2917 North Front Street
Harrisburg, PA 17110-1223
Attorney for Plaintiff
4821.2.1/Notice/SSS/gcp 03/11/99 3:29pm
ADOPTION SERVICES, INC.,
plaintiff
IN THE COURT OF COMMON PL.EAS
CUMBERLAND COu~TY, PENNSYLVANIA
v.
NO. 98-7091 EQUITY TERM
MAURICE G. BLANCHETTE and
FRANKIE SUE BLANCHETTE,
husband and wife,
Defendants
CIVIL ACTION - IN EQUITY
TO: MAURICE G. BLANCHETTE and FRANKIE SUE BLANCHETTE,
husband and wife
DATE OF NOTICE: March 11, 1999
IMPORTANT NOTICE
YOU ARE IN DEFAULT BECAUSE YOU HAVE FAILED TO ENTER A WRITTEN
APPEARANCE PERSONALLY OR BY ATTORNEY AND FILE IN WRITING WITH THE
COURT YOUR DEFENSES OR OBJECTIONS TO THE CLAIMS SET FORTH AGAINST YOU.
UNLESS YOU ACT WITHIN TEN DAYS FROM THE DATE OF THIS NOTICE, A
JUDGMENT MAY BE ENTERED AGAINST YOU WITHOUT A HEARING AND YOU MAY LOSE
YOUR PROPERTY OR OTHER IMPORTANT RIGHTS. YOU SHOULD TAKE THIS NOTICE
TO A LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR C~~OT AFFORD
ONE, GO TO OR TELEPHONE THE FOLLOWING OFFICE TO FIND OUT WHERE YOU CAN
GET LEGAL HELP.
Cumberland County Bar Association
2 Liberty Avenue
Carlisle, PA 17013
(717) 249-3166
,~J~
Stuart S. Sacks, Esq.
I.D. No. 18059
SMIGEL, ANDERSON & SACKS
2917 North Front Street
Harrisburg, PA 17110-1223
Attorney for Plaintiff
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4821.2.IJCLAllkclRulc: to Shnw ('au~c/March 24, 1991) 2:J~ I'M
ADOPTION SERVICES, INC..
PLAINTIFF
IN THE COURT OF COMMONS PLEAS
CUMBERLAND COUNTY.
PENNSYLVANIA
V,
NO. 98-7091
MAURICE G. BLANCHETTE and
FRANKIE SUE BLANCHETTE.
Husband and wife,
CIVIL ACTION - EQUITY TERL\1
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DEFENDANT
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You are hereby notified that ajudgment in the amount ofSI6,556.00 was entered against
NOTICE OF ENTRY OF .JUDGMENT
c,.
TO:
FRANKlE SUE BLANCHETTE
YOll on MarchJt: ~"r999 for failure to respond to the Complaint filed against you in this matter.
Date: \.j'k4..-d...... .:n. I q tj <1
CJ /J .fl
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Prothonotary . . I
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4821.2.I/CLAltkc/Rulc: tt} Show Causell\.larch 24, 19992;32 Pl\.t
ADOPTION SERVICES, INC.,
PLA[NT[FF
IN THE COURT OF COMMONS PLEAS
CUMBERLAND COUNTY,
PENNS YL VANIA
V.
NO. 98-709 [
MAURICE G. BLANCHETTE and
FRANK[E SUE BLANCHETTE,
Husband and wife,
CIVIL ACTION - EQU[TY TERM
DEFENDANT
NOTICE OF ENTRY OF .JUDGMENT
TO: MAURICE G. BLANCHETTE
You are hereby notified that a judgment in the amount of S [6,556.00 was entered against
you on MarchJ& ':'1999 for failure to respond to the Complaint filed against you in this maner.
Date: !'vu" <A-. .:2 r,..
(~,.I/ , Ii?
Prothonotary
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ADOPTION SERVICES, INC.,
PLAINTIFF
IN THE COURT OF COMMONS PLEAS
CUMBERLAND COUNTY,
PENNSYL VANIA
v.
NO. 98- 709 I
MAURICE G. BLANCHETTE allll
FRANKIE SUE BLANCHETTE,
Husband and wifc,
CIVIL ACTION .. EQUITY TERM
DEFENDANT
MOTION FOR DEFAULT ,IUDGMENT
NOW COMES thc Plaintiff, by its attomcys, Smigcl, Anderson & Sacks, and makes the
following Motion pursuant to Pa. R. C. P. No. 1037(c):
1. This action was commcnded by Complaint on Dceembcr 16, 1998. A copy of
said Complaint is attach cd hcrcto as Exhibit "A".
2. The Complaint was served on the Defendant Mauricc G. Blanchette on Deccmber
30,1998, and was served on the Defendant Frankie Sue Blanchette on February 17, 1999.
3. On March II, 1999, each Defendant \Vas served a Ten (10) Day Notice pursuant
to Pa. R. C. P. No. 237.1 and 237.5.
4. Defendants have failed to respond to the Compl:Jint and/or the Ten (10) Day
Notices.
5. Plaintiffs have already tiled a praecipe for a default judgment for liquidated
money damages.
6. Plaintiff's Complaint also requests that Plaintiffbe awarded reasonable counsel
fees to enforce its contract with Defendants.
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7. Plaintifrs Complaint also requcsts that Dcfcndants bc ordcrcd to providc pictures
of andupdatcs about thcir adoptcd ehildrcn to thc Plainti ff in accordancc with Paragraph 17 of
thcir Prospectivc Adopting Parcnts Contract.
8. Pa. R. C. P. No, 1037(c) provides that "'n all cascs, thc court, on motion ofa
party, may entcr an appropriatcjudgmcnt against a party upon default or admission,"
9. Plaintiff: to date, has inclllTcd additional costs and attorncys' fees totaling Onc
Thousand Two Hundrcd Forty-six ano 00/1 00 Dollars ($1,246.00), as evidcnced by the attached
statement marked Exhibit "8".
WHEREFORE, Plainti ff prays that this honorablc eourt enter an ordcr:
A. Rcquiring Defcndants to provide pictures of and updatcs about their adopted
children to the Plaintiff in accordance with Paragraph 17 of their Prospectivc Adopting Parcnts
Contract.
B. Requiring Defcndants to pay Plaintiff the sum oftotaling One Thousand Two
Hundred Forty-six and 00/100 Dollars ($1,246.00) for attorneys' fees and costs inclIITcd to date
in enforcing the parties' contract; or such highcr amount as may evcntually bc incurred as a
result of enforcing said contract.
C. Granting such other relief as the co1ll1 dccms appropriate.
Respectfully submitted,
,.." /1' I
Date: /,,,, ((, \
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SMIGEL, ANDER~.ON & SACKS
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C. Lee Andcrson, Esquire
J.D.#~ 21315
2917 North Front Street
Harrisburg, P A 17110
(717) 234-2401
Attomcys for l)!aintiff
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CERTIFICATE OF SERVICE
\, C. Lee Anderson, hereby certify that a true and con.ect copy ofPlainlitrs Motion for
Default Judgment was served upon the following as addressed below by depositing the same in
the United States Mail, first class, postage prepaid, on Mareh NL 19<)9:
Frankie Sue Blanchette
8105 Bear Hill Road
Royse City, TX 75189
Maurice G. Blanchette
8105 Bear Hill Road
Royse City, TX 75189
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C. L9 nderson, Esquire
1.0.11: 21315
2917 North Front Street
Harrisburg, P A 17110
(717) 234-2401
Allomeys for Plaintiff
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v.
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
.r:? .,d" ----f.'-
NO. (7I'. '709/ T--/ ~-
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ADOPTION SERVICES, INC.,
plaintiff
MAURICE
FRANKl E
husband
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YOU HAVE BEEN SUED IN COURT. If you wish to defend a:gaihst The
claims set forth in the following pages, you must take action within
twenty (20) days after this Complaint and Notice are served, by
entering a written appearance personally or by attorney and filing in
writing with the Court your defenses or objections to the claims set.
forth against you. You are warned that if you fail to do so the case
may proceed without you and a judgment may be ente~ed against you by
the Court without further notice for any money claimed in the
Complaint or for any other claim or relief requested by the Plaintiff.
You may lose money or property or other rights important to you.
G. BLANCHETTE and
SUE BLANCHETTE,
and wife,
Defendants
CIVIL ACTION . IN
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YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE.
HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE
FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP.
IF YOU DO NOT
THE OFFICE SET
cumberland County Bar Association
2 Liberty Avenue
Carlisle, PA 17013
(717) 249-3166
NOT I C I A
Le han demandado a usted en la corte. Si usted quiere defenderse
de estas demandas expuestas en las paginas siguientes, usted tiene
viente (20) dias de p1azo al partir de la facha de la demanda y la
notificacion. Usted debe presentar una apariencia
escrita 0 en Persona 0 por abogado y archivar en 1a corte en forma
escrita sus defensas 0 sus objectiones alas demandas encontra de su
persona. Sea avisado que si. usted no se defiende, la corte tomara
medidas y puede entrar una orden contra usted sin previo aviso 0
notificacion y por cualquier queja 0 alivio que es pedido en la
peticion de demanda. Usted puede perdcr dinero 0 sus propiedades 0
otr.os derechos importantes para listed.
LLEVE ESTA DEMANDA A UN ABODAGO INMEDIATAMENTE. 5I NO TIENE
ABOGADO 0 SI NO TIENE EL DINERO SUFICIENTE DE PAGAR TAL SERVICIO, VAYA
EN PERSONA 0 LLAME POR TELEFONO A LA OFICINA CUYA DIRECCION
SE ENCUENTRA E5CRITA ABAJO PARA AVERIGUAR DONDE SE PUEDE CON5EGUIR
A5ISTENCIA LEGAL.
Cumberland County Bar Association
2 Liberty Avenue
Carlisle, PA 17013
(717) 249-3166
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4B21.'.1/Compla1nt/SSS/gcp 12/03/96 3:56pm
ADOPTION SERVICES, INC.,
Plaintiff
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
NO. 'I f- 10 <) I Ef~'! I..L~-
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v.
MAURICE G. BLANCHETTE and
FRANKIE SUE BLANCHETTE,
husband and wife,
Defendants
CIVIL ACTION - IN EQUITY
COMPLAINT
AND NOW comes ADOPTION SERVICES, INC., by its attorneys SMIGEL,
ANDERSON & SACKS, and avers the following:
COUNT I - SPECIFIC PERFORMANCE
1. Plaintiff is Adoption Services, Inc., an adoption agency
licensed in the Commonwealth of Pennsylvania, with its principal
office at 28 Central Boulevard, Camp Hill, cumberland County,
Pennsylvania.
2. Defendants are Maurice G. Blanchette and Frankie Sue
Blanchette, husbane and wife, whose current address is 8105 Bear Hill
Road, Royse City, Texas 75189.
3. Plaintiff provides adoption services, including intermediary
services to arrange adoptions between biological parents and adopting
parents.
4. The services of the Plaintiff were provided to Defendant
pursuant to a contract, which was executed by the Defendants at the
offices of the Plaintiff on August 11, 1997. A copy of the contract,
entitled prospective Adopting Parents Contract, is attached hereto as
Exhibit "1".
~.--
, .
S. Pursuant to the Contract, the Plaintiff placed two children
for adoption with the Defendants on August 14, 1997. For purposes of
this Complaint, the children are referred to as Dylan and Daniel.
6. The two children were adopted by the Defendants before the
Cumberland County Court on November 10, 1997.
7. Paragraph 17 of the Contract requires, inter alia, the
Defendants to provide pictures and updates about the children to
Plaintiff for approximately eighteen years.
8. Defendants are aware that the requirement for pictures and
updates is a contractual requirement and is also relied upon by the
biological mother.
9. plaintiff has made numerous and repeated requests to the
Defendants to provide the pictures and updates, but they have refused
or failed to do so.
10. Paragraph 20 of the Contract obligates the Defendants to
pay, inter alia, any and all legal fees incurred by Adoption Services,
Inc. to enforce the Contract.
WHEREFORE, Plaintiff prays this Honorable Court to enter an Order
requiring the Defendants to comply with Paragraph 17 of the Contract
to supply pictures and updates for the duration of the time specified
in the contract, and to pay reasonable counsel fees incurred by the
Plaintiff, together with costs.
COUNT II -IN ASSUMPSIT
11. Plaintiff hereby incorporates the averments of paragraphs 1
through 10 by reference, as if more fully set out hereafter.
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12. Pursuant to the Contract of August 11, 1997, the Defendants
have failed to pay Plaintiff, for services rendered, the sum of
$16,361.00, evidenced by the invoice dated November 25, 1998, attached
hereto as Exhibit "2" and incorporated herein by reference.
13. Despite numerous demands by. Plaintiff, Defendants have
failed or refused to pay for the services rendered as set forth in
Exhibit "2".
14. Plaintiff also placed two other children with Defendants for
which there are outstanding balances owed.
15. In 1996, Plaintiff placed a child with the Defendants, said
child known as Taylor, who was also adopted by the Defendants in 1997
before this Court.
16. There remains a balance due of $95.00 for the placement of
Taylor, as represented by the invoice attached hereto as Exhibit "3".
17. Despite numerous and repeated requests by the Plaintiff,
Defendants have failed or refused to pay the $95.00 due as represented
by the invoice attached hereto as Exhibit "3".
18. In 1997, the Plaintiff placed a child with the Defendants,
said child known as Dominic, who was also adopted before this
Honorable Court in 1997.
19. For the placement of Dominic, there remains a balance due of
$100.00, as represented by the invoice attached hereto as Exhibit "4".
20. Despite numerous and repeated requests by the Plaintiff,
Defendants have failed or refused to pay the $100.00 due, as
represented by the invoice attached hereto as Exhibit "4".
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21. Defendants entered into Contracts for the placement of
Taylor and Dominic. attached hereto respectively as Exhibits "5" and
116" .
22. The Contracts for the placement of the children require.
inter alia. the Defendants to pay Plaintiff's reasonable counsel fees
and expenses to enforce the provisions of the Contracts.
WHEREFORE. the Plaintiff prays this Honorable Court to enter
judgment against the Defendants for all three contracts in the total
amount of $16.556.00. together with reasonable counsel fees and
expenses as may be awarded by the Court.
Dated:
December 771<-. 1998
~
~t S. Sacks.
I.D. No. 18059
SMIGEL. ANDERSON & SACKS
2917 North Front Street
Harrisburg. PA 17110-1223
(717) 234-2401
.~
Esq.
Attorney for Plaintiff
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VERIFICATION
I, vincent F. Berger., Ph.D.; President of Adoption Services,
Inc., a licensed adoption. agency in the Commonwealth of Pennsylvania,
verify that the statements contained in the foregoing Complaint are
true and correct to the best of n~ knowledge, information and belief.
I understand that false statements therein are made subject to the
penalties of 18 Pa.C.S. ~4904, relating to unsworn falsification to
authorities.
vintt~~
ADOPTION SERVICES, INC.
28 Central Boulevard
Camp Hill, PA 17011
President
Date: December
:j-,
1998
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a t Adoption Services, Inc.
, .28 Central Boulevard' Camp Hill, PA 17011 . (717) 737.3960' FAX (717) 731-0157
PROSPECTIVE ADOPTING P~~NTS CONTRACT
We (I),
parents and request
state that we (I):
the undersigned, are interested in becoming adoptive
the assistance of Adoption Services. Accordingly, we (I)
1. have read and understand the current Adoption Services Program
Description and Fee and Service Schedule;
2. state that, with the exception of the information as specifically stated
in'. the Program Description and Fee and Service Schedule, no promises
and/or guarant.ees of any kind have been made or iinplied to us . (me) by
Adoption Services or its staff;
3. understand' that we (I) will be notified of any changes in the current
Fee and Service Schedule that will apply to us (me) and agree to pay
Adoption Services for services rendered in accordance with the Fee .and
Service Schedule that is in effect at the time the services are
rendered;
4. understand that if we (I) provide false or misleading information to
Adoption Services, we (I) forfeit our (my) right to any refunds as
stated in the .Adoption Services Fee and Service Schedule;
5. consent that Adoption Services and Adoption Services staff be permitted
to obtain copies of, and examine all, our (my) psychological, medical,
legal and other records and to interview all professional and lay
persons who might provide information regarding these records or provide
information related to our (my) desire to adopt a child; we (I) will
sign a release of information authorization form, as requested;
6. understand that the information given to Adoption Services as part of
the Registration, Application, Home Study processes and post-placement
visitations, may be contained in written and/or verbal reports prepared
by Adoption Services and given to necessary attorneys, courts, other
agencies,or government authorities as may be required. Furthermore, we
., , (I) understand that any and all information ,and records related to the
~,' adoption process maybe admitted as courtroom evidence and that Adoption
Services may use any and all information as part of its preparation for
courtroom testimony; ..',
EX..'libit "1"
Page 1 of 6
".
7. understand that we (I) mayor may not agree with part of, or all of, any
reports, statements, conclusions and recommendations made by Adoption
Services regarding our (my) desire and/or fitness to adopt a .child;
however, we (I) hereby release Adoption Services and/or its staff from
any and all liability arising from information contained in their
reports and/or conclusions and/or reco~nendations;
8. understand that a Home Study and/or Pre-placement Report completed by
Adoption Services does not in any way guarantee that a child referral
will be made by Adoption Services or that the Adoption Services' Home
Study or Pre-Placement Report will be accepted by other private agencies
and/or local courts; and
9. agree to keep Adoption Services informed of any material changes or
anticipated changes in our (my) health or family including separation,
marital changes, pregnancy, change of residence, change of employer and
change in family structure; .
. Additionally, if .':we (I) have requested the assistance of Adoption
Services. in' matching -us (me) with a US-born infant/child available for
adoption, we (I) state that we (I):
,. .
10. understand that in all domestic (US) adoptions at least three post-
placement visitations are required by Adoption Services and/or by state
law/regulations. Should .we. (I) not comply wi.th this requirement, we (I) ..
unders~and that the placement of the child may be in jeopardYi however,
in such instances, we (I) release Adoption Services from any and all .1
liability therefrom.
11. understand that in cases involving the placement of a child, such
placement will likely take place prior to the termination or
relinquishment of the biological parents' rights. In such instances, we
(I) recognize that, prior to the termination or relinquishment of
parental rights, either biological parent may change their mind
regarding the adoption process and may request the return of the child.
We (I) also recognize that the request for return, and return, of the
child could result in emotional turmoil and financial loss to us (me),
including the loss of Adoption Services' travel fees, the birthparents'
and. agency's attorneys fees and birthrnother and baby hospital/medical
related costs. In such an instance, we (I) release Adoption Services
from any and all liability therefrom. Furthermore, in such an instance,
. we (I) agree to deliver the child to the Adoption Services' office on
.the. date and time requested by Adoption Services. In the event that we
(I) fail:to comply with the demand to return the child, we~(I) authorize
. the ..agency to disclose our (my) identity to the natural parents .and to
:.' .: .any, ;and .all ;'othe'r 'persons .: as . deemed necessa:::y by. the agency. to permit
,;.:the./birthpa.rents ,to .pursue the return of their:child. Additionally, we
.. (I) .agree ;to '.pay) for .anyand all .time and legal fees incurred by
Adoption Services to enforce the above;
Page 2 of 6
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l2. understand that Adoption Services asks that each birthmother and, when
possible, each birthfather complete a Birthparent Health and Genetic
History Information Form. Th,e birthmother is also asked to sign a
release form allowing medical information and hospital records to be
released to Adoption Services and/or its attorney. \'Ie (I) understand
that we (I) will be given copies of the Birthparent Health and Genetic
History Information Form with the .identifying information removed. We
(I) understand, and fully acknowledge, that the medical information
given to Adoption Services and passed onto us (me) may be incomplete or,
. at times, misrepresented by the birthparents. We (I) .understand that
Adoption Services does not make an independent investigation into the
birthparents'. background other than to determine their intentions and
family history through interviews and conversations. Therefore, we. (I)
understand Adoption Services cannot represent any and all of the risks
for the child' 5 health which may materialize in the present. and/or.
future. Accordingly,.we (I) hereby release Adoption Services and/or its
staff from any and all liability arising from information, lack of
information or misinformation contained in information given to us (me)
about the backgrounds and medical conditions .of the birthmother,
birthfather, ~peir families and the child;
13. acknowledge and agree that Adoption Services cannot predict. an
adoptive child' s future including, but not limited to, emotional
and/or personality. : characteristics, health, medical problems,:.:
learning disabilities, intellectual ability, hyperactivity,
attention .deficits, . appearance or inherited characteristics. .We
(I) further.acknowledge that.information provided by, and through,
the Agency may be incorrect because any medical and social history
and other information obtained by the Agency has been provided by
birthparents and/or by various other sources;
l4. understand that, at the time we take custody of a child, we must escrow
anticipated birthrnother and child medical fees. These moneys will be
escrowed with the agency's attorney. We (I) understand and agree that
all medical bills be paid. prior to the time of the final adoption
hearing'. Accordingly, we (I) agree that any medical bills/charges
outstanding just before the final adoption hearing will be paid from our
escrow account. We .(1) can then, on our (my) own, continue to resolve
any insurance reimbursement, although we (I) understand that insurance
reimbursement may not take place;
15. understand that there may be occasion when all medical bills.. are not
known or. presented to us (me) .at the time of placement.or even. at the
time of finalization. ~Because. of l unforeseen circumstances,. .including
insurance reimbursement requirements, any medical: bills presentedcto us
(me), even after the placement and adoption are completed, will remain
our responsibility. and .wei(I) agree.to.pay.any such medical bills:within
30 days of receipt of..thebill(s);'" .,:. .,.
16.
agree to. give Adoption Services the right to remove and/or
removal. . of.~. the ..child' from.' our family and terminate
relationship with us (me) should, prior to finalization of
such action be deemed necessary by Adoption Services;
recommend the
the ;child's
the adoption,
Page 3 of 6
"
17. agree to provide Adoption services with pictures of, and updates on, the
child we (I) adopt. These pictures (at least twelve each time)will;be
. provided at a. minimum of three-month" intervals for the first year..:after
placement and at a minimum of twice per year (in December and May)..:for
the next four (4) years" . All pictures are to be in focus" with' the
chilp. , s features clearly visible. The pictures will be. of the. .same
quality as those normally included in my/our family picture albur.\...' The
c updates are to be at least one page in length (approximately 250-300
word minimum) and should be .of a quality you would send to .a close
relative. Additionally, unless this sentence has been crossed 'out .and
initialed, we' (I) 'agree to provide a.. "school picture" and update in
December of each year, covering ages 5 through 18. Each time pictures
c'. . are sent;-we (I) .agree to provide to Adoption Services a .written update
, '.. regarding '.the child and, his/he.r .development. We. (I) understand . that
. :.these. pictures ;and. written.'. updates may be transmitted ,.to'I~the
birthparent(s).. ,'We:' (I) . understand and agree that this Contract,.
including this -.section,. . shall. survive the final adoption of a .child by
us (me) 'and.shall no~ be te~ina~~d by an adoption decree;
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18. understand that'.by accepting physical.custody of a child placed with us
(me), we (I) agree to, and shall, provide all necessary care of the
child until the.' placement is 'terminated" or concludes in . adoption.
Should .the placement be terminated. for any reason, we (I) .release
Adoptiori.Services'from.anyand all liabilitytherefrorn;
\',> .
19. understand that. confi.dentiality. is important to birthparents. and to
adoptive' families. While Adoption Services will take precautions to
protect our (my) identity and that of. the birthparents, by our '(my)
design, the birthparent's design 'or by some possible error on ,the part
of Adoption Services, the hospital or attorneys involved, our (my)
identity and that of the birthparents could be divulged. If such
happens, we (I) release Adoption Services from any and all liability
therefrom.' Additionally, we (I) understand that, in some instances,
adoptive parents who prefer anonymity may be confronted with
birthparents who, subsequent 'to placement, but prior to termination or
relinquishment, request a meeting with, or other identifying information
of, ,.the. adopting family.. In such ,situations, we (I) agree to ',either
.:. cooperate with the birthparents' request or, if so requested'by.:'the
birthparents,we (I) will return the child to Adoption Services; ,-,.
-,;,.
20. understand and agree that should we (I) violate any of the a.bove
Contract, .. we,.; (I) agree ~ to pay, any. and ;all legal, fees incurred by
Adoption Services to.enforce:the:abbvc,and we (I) .agree to pay.Adoption
. ~: .Servi.ces' ..current .hourly rate',for}any ..and :all time -expended by Adoption
.': .Services'. B~aff.i:cgardihg '.this violation; 2.:' .; ..~,-.,,:, _ .,'.,~ ..',. c,,::::.";!.it:," ~
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21; ;., :undeistand ,.thil,twe ,,( I) , must "90mply',with Jill"of ,.the ; above ,sections ;Ias a
condition of the ,agency's Consent ,to Ithe' ,ndoption; .;., ;,l:.'.', :.. .'~i.:.).':!.,t,
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22. ~ understand .and 'agree :.that ,this JContract :shall Burvivcthcfinal adoption
. ". 'of. a child' by. us' (me) and :.ahall ~ not be tei:minstcd' by .'any' 'adoption
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. Additionally, if we (I) have requested the assistance of. Adoption
Services' In. matching" us (me)' 'with' a .Chinese-born, ,.Moldova-born,
pridnestrovie-born . or Russian:"born infant./child available for ~dciption, we
(I) stat.c that we (I): ..., .,~:.
23.
24.
25.
." .. ".' ...
ac~riciwledge::t:h~t th,e. 'yai:~,!us .Coo.rdinat.,!rs ,and Goverrunenta:La,g~nci,es
in the fore~gn country to whom we are. referred are .not employees of
Adoption .Services. and; . thereOf,oie.,.t,he .Ag~ricy . is. not responsible';in
an~ :fas}~io~, :.?r., llIanne:t; for the lor ~c.t~.on~ i: ,.. . . .....
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acknowledge and understand that any fees charged lon, and/or by, the
fore.i.gl}.. co.untry, such. as.the d(~mations. to the Orphanage,.. child's
visa., ;~l;c. ,::ar.e..to be .paid by us (me). Ad,gtionally, travel,; food
and.lodging.~re the. Adoptive. Parent's. sole.responsibilitYi .,; : ~'
understand and agree that no portion .of fees paid. to Adoption
Service~ are, fgr. legal .s.ervices .and/or: costs :.in.. obtaining. a us
birth certifical;e, regist7ring .the adoption, in a state court and/.or
ohl;aining United states.C~ti.z.€?n,!~ip; _. '.......,.., .:,...;.... .". ... .. ....
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26. acknowledge, understand and agree that Jl.doption Services is not
responsible for any foreign fees, expenses, travel expenses and/or
cost of any kind or..nature.,that we (I) incur. in the event that an
adoption .is.notcompleted~ ,. ... . '
27. understand and agree that in the event that after placement, but
before finalization, a condition develops or is made known to liS
(me) which causes us (me) to end the placement, we (I) understand
that no portion of the fees we (I) have paid will be refunded and
that Adoption Services shall not be responsible to us (me) for any
damages relating to the placement; ... . .
28. acknowledge that Adoption Services is not responsible for our (my)
safety and/or safety of the child at any time during the adoption
process;
29.
30.
understand that the results'- ~f any medical tests and exalns for the
child will'be--given .to us" (me)!:but ,understand.'. and ';agree. that the
Agency does not guarantee the accuracy of these repc:cts. We . (I)
accept such risks in accepting the plac~ment of a child;
. . . ", , ~, '.. . ." .' .t" , . . ..,'. . .. '.. .
acknowledge . and agr'ee '~that .. Adoption . Servlcei:i ., cannot . pi-.edict'. 'an
adoptive child 's future including,:.. but ,not . limited to,:, (~motional
and/or personality. characteristics, health, ..medical . problems,
learnit;g~.: .dis.a~ili.Fe~~.':'.~:'):ntell~7~ual..;..abi~ity',' '. hYl?eIa<?~i.~~ty,
attent~on ,def~c~t5, : appearance' or 'inher~ted . character~stici!. ';'.-,We
(I ) further" acknowledge that' information provided by, and through, ,.
the Agency may be incorIect because any medical and social history
and other information obtained by the Agency has been provided-by
the birthparents and/or by various other sources;
., .:.; .J _';. I ~
Page 5 of 6
..~ ...'.....---
.~ t, ",'\1 .;;:~:,> >~,",', :.,::(._~~:~,,".J ,,,'~.. . "'''. ,'.' ':r~,.~, ~.,~'W.^~..~~ ~'-. .~, ~ ". .,..). ~.... "...
31.
32.
33.
#'f" '. -..
34.
understand that by accepting physical custody of a child .placed
with us (me), we. (I) . agree to, and. shall, 'provide .all...riecies~ary.
care of the child until the placement is terminated or concludes in ..
adoption. Should the placement be .terminated . for any. r.eason, we
(I) release Adoption Services from any and all liability therefrom;'
understand and acknowledge that if a condition arises after the
finalization of the adoption, the child is ours (mine) and.cannot
be returned "to. Adoption '.Services. and/or. the authorities. from the
foreign country. from which the '. child .~a:s' aaopted.: We::( I). "accept
such risk and agree that Adoption Services .shall"not'be.responsible
to us (me) or to our (my) child for any damages relating to-any.
condition;
,".:; ,'''(.::' :o\~...~': :t' -. ~.....:.: .....:,...;,::;........... ....- ....,..
under'stand and accept 'all therisksirivolv~d .and .we (I) will. accept
our ""(my) ,: adoptive child and hold. the fAgeincy, .:its Directors,
facilitators, 'officers .and. employees .harmless.' and release'.':'said
Agency from any claims or liability;
..;....~: -;": .:'1" ''::fJ.~. ~-:21;.<: :.; :;l:...::_~:C ;:.. ',:," ...:..... ..' ....., .' -- .-_.
agree. that in 'the '. event that.. we (I I file any claim.. or action
against Adoption Services, 'without.'regard to'the results,."we (I)
agree to pay Adoption Services all cost 'it incurs in. defending our
(my) claim.
, . .. ~'..:f. ......'..., .:1.;~....","~ .r.,;r#..T-."'''~ "."'''~''.l-"~""..''t';I,.~:",....y,,.1't!,~t<"'1,.~fior..~.::<,"'':.../,_,..,..:;,:,,:.~. .... ''':4.~.. ':..' ~....~. ...... ,......' __. ."
. . . .
. .
....:!!.
We (I), the undersigned, have read the.above':Contract. and/or it has
been read to us (me) and we (I) understand and agree to all its provisions.
QjZJJU fXu '--i3L 1Hh
Prospective Adopting Parent
941 J~2
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Page 6 of 6
. ,
.....r-I~
Ad~ption Services, Inc.
28 Central Blvd.
Camp Hill, PA 17011
13:08
TO:
Mo & Frankie Blanchette
8105 Bear Hill Road
Roy,e Cily TX 75189
~ t/-3
r
Statement
E 1~~:8 -3
AMOUNT DUE AMOUNT ENe.
$16,361.00
DATE TRANSACTION AMOUNT BAI.ANCE
12131/95 Balance forward 0.00
08/13/97 !NY '5604 975.00 975.00
08113197 PMT #1879 -975.00 0.00
08/15197 INV '5610 1.350.00 1,350.00
08/15/97 ,NY 115611 405.00 1,755.00
08127197 (NY '5632 13.150.00 14,905.00
11/07/97 INV 115758 1,200.00 16,105.00
11/08197 INY #5760 200.00 16,305.00
11114197 INV #;768 5600 16,361.00
CURRENT
0.00
A pAST
QUE
31-60 DAYSPASrr61.90 OAY'StsAST I j
DUE DUE I PAST DUE _
0.00 L 000 I 16,361.00
-____ __.___--l_.______.u___ _
AMOUNT DUE
. ,~' . ..'. ': '. \:11:1:".' f ': .) ;;~":, :.'.' :". ",;:.... .~?e~~. .-<<.--,;.--:.... .f'lIII'.".,+",,,) ,;.,.-.: ",<"....".., '~~'I~ ~l.-"'nl?, ~. ~ ~ ~ -', .., ", ....':~.."~: : ..' !, .'. ,
000
$16.361.00
Exhibit
II,,>"
~
.....,!~.-'..,,-~....."'"
.......
Adoption Services, Inc.
28 Central Blvd.
Camp Hill, PA 17011
f4~~ 1i /
Statement
r~~
~~J
TO:
----l
Bl3nchctfC, M.1uricc: & Frankie---..---------
BIOS Bear Hill Road
Royse City TX 751B9
AMOUNT DUE AMOUNT ENC.
$95.00
DATE TRANSACTION AMOUNT BALANCE
12131/95 Balance forward 0.00
05/17/96 lNY N4BB9 _ 475.00 475.00
05/17/96 PMT #1303 -475.00 0.00
06/12,196 (NY #4933 - 5.00 5.00
06/13/96 PMT#11727 -5.00 0.00
07/10/96 INV 1/4999 - 20.50 20..50
07/10/96 INV #5002 - 3,275.00 3,295..50
07/11/96 PMT #1372 -3,295.50 0.00
OB/02J96 !NY 1IS057 _ 1,140.00 1,140.00
09/04/96 PMT #1454 -1,140.00 0.00
10t1l2J96 INY #5170- 190.00 190.00
11/01/96 INY #5215 _ 1,615.00 1,80S.00
01120197 PM"!' #1636 -1,B22.00 -17.00
04t1l2J97 INV #5410/11 13,017..50 13,OOa.50
04/02197 L"Y #5412 68.36 13,06B.86
06102197 PM"!' #3297 -13,068.86 0.00
06tU6197 INY #5483 9S.00 95.00
CURRENT I-3D DA9Sl5AST 31-60 DAYS PAS151.S0 DA'iSl5A!>'T IIVER9000Ar:> AMOUNT DUE
DUE Due ~TOUE
000 0.00 0.00 _I 0.00 . __9S.00 $95.00
Exhibit "3"
~....t--!~':.>-...::::'~'~"'"
... ~." "
". .._~'~1:j.,~I,,'>t~~.u,'~ ..,~ :.':I:-.~.~-."l-,",.."".-~."~.....-,J-'......,'-',.'~".,~t1....1,\,-.:->.....--''.;.\.:L'1I,~r:,I{.rt<''1I;".",.v.-,.<;.,,; \'.:,.' 4 '.'
11/24/98 13:07
~717 731 0157 ____
ADOPTIO~ S\'CS
....... SACKS
1i!J003
Ad~plion SClViccs, InC.
28 Central Blvd.
Camp Hill, PA 17011
~rf-).
Statement
DATE
-.-----
I112S/98
TO:
Mauri", & Frankie B1ancheu,
8105 Bcarllill Road
Royse City TX 75189
AMOUNT DUE AMOUNT ENC.
SIOO.oo
DATE TRANSACTION AMOUNT BALANCE
12131/95 Balance forward 0.00
02124/97 lNV #5356 975.00 975.00
02124/97 PMT #1525 -975.00 0.00
03f26/97 lNV #5391 427.50 427.50
03/26/97 mv #5392 1,235.00 1,652.50
03126/97 INY #5393 190.00 1,852.50
03126/97 INY #5394 190.00 2,042.50
04/08/97 INV 1/5422 6,295.00 8,337.50
07131/97 PMT #1876 -8,337.50 0.00
07131/97 INY #5585 1,140.00 1,140.00
08~S/97 INY #5595 43.79 1,183.79
09129/97 PMT #194-1 -1,183.79 0.00
10102197 INV #5698 100.00 100.00
CURRENT I '-30 0""-""'1"'"' """'''''1'"''' lM'm>A"j ""101" _I AMOUNT DUE
DUE DUE I DUE PAST DUE
0.00 0.00 --1 0.00 - - 000 10000 - $100.00
--- - _--1._______ _.____
Exllibit "4"
"'....' "
~~"',.".~...'..1.~'. ~' '"... "\',:,",:,'~;' ,.~, ,/ t,'.
12101/98 15:01
~717 731 015~
. H S.\CKS
----------.--
7(J./(1(,
,,' Adoption Services, Inc.
'\ 28 Central Boulevard. Camp HilI, PA 17011 . (717) 737-3960. FAX (717) 731.0157
PROSPECTIVE ADOPTING PARENTS CONTRACT
.. .
,
We (I),
parents and request
state that we (I):
the undersigned, are . interested in becoming adoptive
the assistance of Adoption Services. Accordingly, we (I)
1. have read and understand the Adoption Services Program Description (Rev.
5/96) and Fee and Service Schedule (Rev. 7/96);
2. state that, with the exception of the information as specifically stated
in the Program Description and Fee and Service Schedule, no promises
and/or guaraI:ltees of any kind have been made or implied to us (me) by
Adoption Services or its staff;
3. understand that we (I) will be notified of any changes in the current
Fee and Service Schedule that will apply to us (me) and agree to pay
Adoption Services for services rendered in accordance with the Fee and
Service Schedule that is in effect at tho time the services are
rendered;
4. understand that if we (I) provide false or misleading information to
Adoption Services, We (I) forfeit our (my) right to any refunds as
stated in the Adoption Services Fee and Service Schedule;
5. consent that Adoption Services and Adoption Services staff be permitted
to obtain copies of, and examine all, our (my) psychological, medical,
legal and other records and to interview all professional and lay
persons who might provide information regarding these records or provide
information related to our (my) desire to adopt a child; we (I) will
sign a release of information authorization form, as requested;
6. understand that the information given to Adoption Services as part of
the Registration, Application, Horne Study processes and post-placement
visitations, may be contained in written and/or verbal reports prepared
by Adoption Services and given to necessary attorneys, couJ:.ts, other
agencies or government authorities as may be required. Furthermore, we
(I) understand that any and all information and records related to the
adoption process may be admitted as courtroom evidence and that Adoption
Services may Use any and all information as part of its preparation for
courtroom testimony;
Exhibit "5"
P.1ge 1 of 6
; -:..t.~'.. ._..~_".~
. . .. .'~,~ - '''1\ ~'.' ". '." :,.j ',I' '. '."~~' , .- ,,_,.,; "''''''~:.. 't>Jt::-,~""~:::' j:- -:, . ~ :-.. .-;.. ". .
. . I ,'., '. . .
15: 01
7. understand that we (I) mayor may not agree with part of, or all of, any
reports, statements, conclusions and reconunendations made by Adoption
Services regarding our (my) desire and/or fitness to adopt a. child;
however, We (I) hereby release Adoption Services and/or its staff from
any and all liability arising from information contained in their
reports and/or conclusions and/or reconunendations;
8. understand that a Home Study and/or Pre-placement Report compl'i~ted by
Adoption Services does not in any way guarantee that a child referral
will be made by Adoption Services or that the Adoption Services' Home
Study or Pre-Placement Report will be accepted by other private agencies
and/or local courts; and
9. agree to keep Adoption Services informed of any material changes or
anticipated changes in our (my) health or family including separation,
marital changes, pregnancy, change of residence, change of employer and
change in family structure;
Additionally, if
Services in matching
adoption, we (I) seate
we (I) have
\IS (me) with
that We (I):
requested
a US-born
the assistance of Adoption
infant/child available for
10. . understand that in all domestic (US) adoptions at least three post-
placement visitations are required by Adoption Services and/or by state
law/regulations. Should we (I) not comply with this requirement, we (I)
understand that the placement of the child may be in jeopardy; however,
in such instances, we (I) release Adoption Services from any and all
liability therefrom.
11. understf'.'ld that in cases involving the placement of a child, such
placement will likely take place prior to the termination or
relinquishment of the biological parents' rights. In such instances, we
(I) recognize that, prior to the termination or relinguishment of
parental rights, ei.ther biological parent may change their mind
regarding the adoption process and may request the return of the child.
We (I) also recognize that the request for return, and return, of the
child could result in emotional turmoil and financial loss to us (me),
including the loss of Adoption Services' travel fees, the birthparents'
and agency's attorneys fees and birthmother and baby hospital/medical
related costs. In such an instance, we (I) release Adoption Services
from any and all liability therefrom. Furthermore, in such an instance,
we (I) agree to deliver the child to the Adoption Services' office on
the date and time reguested by Adoption Services. In the event that we
(I) fail to comply with the demand to return the child, we (I) authorize
the agency to disclose our (my) identity to the natural parents and to
any and all other persons as deemed necessary by the agency to permit
the birthparents to pursue the return of their child. Additionally, we
(I) agree to pay for any and all time and legal fees incurred by
Adoption Services to enforce lhe above;
.
Page 2 of 6
.:." :--:~'...._. -
..---..-
.
, -...."':t,.fii., '~"^'r"":"~:<,,:,"." ",'''':~''';~I''''~''?'''\t,:).''"''':~''''~';\:'''~~'~',\'\~':'''~'':. ,'. .'. ',' .
12. understand that Adoption Servi.ces asks that each birtlunother and, when
possible, each birth father complete a Birthparent Health and Genetic
History Information Form. The birtlunother is also -asked to sign a
release form allowi.ng medical information and hospital records to be
released to Adoption Services and/or its attorney. We (I) understand
that we (I) will be given copies of the Birthparent Health and Genetic
History Information Form with the identifying information remov~d. We
(I) understand, and fully acknowledge, that the medical information
given to Adoption Services and passed onto us (me) may be incomplete or,
at times, misrepresented by the birthparents. We (I) understand that
.Adoption Services does not make an independent investigation into the
birthparents' background other than to determine their intentions and
family history through interviews and conversations. Therefore, we (I)
understand Adoption Services cannot represent any and all of the risks
for the child's health which may materialize in the present and/or
future. Accordingly, we (I) hereby release Adoption Services and/or its
staff from any and all liability a.rising from infonnation, lack of
information or misinformation contained in information given to us (me)
about the backgrounds and medical conditions of the birthmother,
birthfather, :their families and the child;
13. acknowledge and agree that Adoption Services cannot predict an
adoptive child's future including, but not limited to, emotional
and/or personality Characteristics, health, medical problems,
learning disabilities, intellectual ability, hyperactlvity,
attention deficits, appearance or inherited characteristics.. We
(I). further acknowledge that information provided by, and through,
the Agency may be incorrect because any medical and social history
and other information obtained by the Agency has .been provided by
birthparents and/or by various other sources;
14. understand that there may be occasion when all medical bills are not
known or presented to us (me) at the time of placement. Because of
unforseen circumstances, including insurance reimbursement requirements,
any medical bills presented to us (me), even after the placement and
adoption are completed, will remain our responsibility;
15.
agree to give Adoption Services the right to remove and/or
removal of the child from our family and terminate
relationship with us (me) should, prior to finalization of
such action be deemed necessary by Adoption Services;
16. agree to provide Adoption Services with pictures of, and updates on, the
child we (I) adopt. These pictures (at least six each time) will be
provided at a minimum of three-month intervals for the first year after
placement and at a minimum of twice per year (in December and May) for
the next four (4) years. Additionally, unless this sentence has been
crossed out and initialed, we (I) agree to provide a "school picture"
and update in December of each year, covering ages 5 through 18. Each
time pictures are sent, we (I) agree to provide to Adoption Services a
written update regarding the child and his/her development. We (I)
understand that these pictures and written updates may be transmitted to
the birthparent(s). We (I) understand and agree that this Contract,
including this section, shall survive the final adoption of a child by
us (me) and shall not be terminated by an adoption decree;
reco~nd the
the child's
the adoption,
Page 3 oi 6
;""'_~.J>~'_' _. ._....
,. .
~ . > .--~, ".:-.:' -;;:t; ";.'."."';. ,. ~'.e. I> ^- ~.._ ..-:: :.'k" \r:,." "'~'," ".... l'~"f'Y~"1 ;I~""'M,~ ~)~~1'.~':., 'I'~~<Y!""'"', '"". ",,,', . ',.' ,'''', "'~' J ";',' , . '
H' S.\CKS
IaJ005
17.
understand that by accepting physical custody of a child placed with us
(me), we (I) agree to, and shall, provide all necesuary care of the
child until the placement is terminated or concludes in adoption.
Should the placement be terminated for any reason, we (I.) release
Adoption Services from any and all liability therefrom;
understand that confidentiality is important to birthparentsal1d to
adoptive families. While Adoption Services will take precaut<ions to
protect our (my) identity and that of the birthparents, by our (my)
design, the birthparent' s design or by some possible error on the part
of Adoption Services, the. hospital. or o.ttorneys involved, our (my)
identity and that of the birthparents could be divulged. If such
happens, we (I) release Adoption services from any and all liability
therefrom. Additionally, we (I) understand that, in some instances,
adoptive parents who prefer anonymity may be confronted with
birthparents who, subsequent to placement, but prior to termination or
relinquishment, request a meeting with, or other identifying information
of, the adopting family. In such situations, we (I) agree to either
cooperate with the birthparents' request or, if so requested by the
birthparents, ~e (I) will return the child to Adoption Services;
.".
18.
19.
understand and agree that should we (I) violate any of the above
. Contract, we (I) agree to pay any and. all legal fees incurred by
Adoption Services to enforce the above and we (I) agree to pay Adoption
Services' current hourly rate for any and all time expended by Adoption
Services' staff l:egarding this violation;
understand that we (I) must comply with all of the above sections. as a
condition of the agency's Consent to the adoption;
21. understand and agree that this Contract shall survive the final ;;'doption
of a child by us (me) and shall not be termino.ted by any adoption
decree.
20.
Additionally, if we (I) have requested the assistance of Adoption
Services in matching' us (me) with a Chinese-born infant/child available for
adoption, we (I) state that we (I):
22. acknowledge that the various Goverrrmentn1 agencies in China to whom
we are referred are not employees of Jl.doption Services and,
therefore,. the Agency is not responsible in any fashion or manner
for their actions; .
23. acknowledge and understand that any fees charged in thc Peoples'
Republic of China, such as the donations to the Orphanagc, child's
visa, etc., are to be paid .by us (meJ. Additionally, travel, food
and lodging are the Adoptive Parent's sole responsibility;
24. understand and agree that no portion of fees paid to Adoption
Services are for legal services and/or costs in obtaining a US.
birth certificate, registering the adoption in a state court and/or
obtatning United States Citizenship;
P"ge <: of G
...'!~l'~...
, : ',' '-;. > ,\,:._7F :.t' ,.~'-1), .": "'~~''''.'r~,~~''''~^,~.'''f".......-:~~~~,-.~r~''~'':~!. :.(".1":""I\'l~t~~'~~'~~~"'"''''''(", ''':, .' ,_ ,:.'....
_.~~_4
.
ll/UI/Y~
15: 0.1
~717 731 0157
IaJ 006
~DOIT.!~_~~_":,~.\~KS _ ___
.-------.--
25. acknowledge, understand and agree that lIdoption Services is not
responsible for any foreign fees, expenses, travel expenses and/or
cost of any kind or nature that We (I) incur in the event that an
adoption iB not completed;
26. understand and agree that in the event that after placement, but
before finalization, a Condition develops or is made known to .us
(me) which causes Us (me) to end the placement, we (I) understand
that no portion of the fees we (I) have paid will be refunded and
that Adoption Services shall not be responsible to us (me) for any
damages relating to the placement;
27. acknowledge that Adoption Services is not responsible for our (my)
safety and/or safety of the child at any time during the adoption
process;
28. understand that the results of any medical tests and exams for the
child will be given to us (me) but understand and agree that the
Agency does not guarantee the accuracy of these reports. We (I)
accept such risks in accepting the placement of a child;
29. .acknowledge and agree that Adoption Services cannot predict an
adoptive child's iuture including, but not limited to, emotional
and/or personality Characteristics, health, medical problems,
learning diSabilities, intellectual ability, hyperactivity,
attention deficits, appearance or inherited characteristics. We
(I) further acknowledge that information provided by, and through,
the Agency may be incorrect because any medical and social history
and other information obtained by the Agency has been provided by
the birthparents and/or by various other sources;
30. understand that by accepting physical custody of a chile- placed
with us (me), we (I) agree to, and shall, provide all necessary
care of the child until the placement is terminated or concludes in
adoption. Should the placement be terminated for any reason, we
(I) release Adoption Services from any and all liability therefrom;
.
31.' understand and acknowledge that if a condition arises after the
finalization of the adoption, the child is ours (mine) and cannot
be returned to Adoption Services and/or Chinese authorities. We
(I) accept such risk and agree that Adoption Services shall not be
responsible to us (me) or to our (my) child tor any damages
relating to any condition;
32. understand and accept all the risks involved and we (I) will accept
our (my) adoptiVe child and hold the Agency, its Directors,
facilitator.s, officers and employees harmless and release said
Agency from any claims or liability;
33. agree that in the event that we (I) file any claim or action
against Adoption Services, without regard to the results, we (I)
agree to pay Adoption Services all cOst it incurs in defending our
(my) claim.
Page 5 of 6
. .' ". . ,
' '" '. . l ." . .':',. '"". . "
' , , .' , .
12101/96
15:05
'8'717 731 0157
~DllJYrIOS Sl'es .,
-H-t SACKS
~007
We (I), the undersigned, have read the above Contract and/or it has been
read to us (me) and we (I) understand and agree to a1.l its provisions.
'Ii: ll'
r~. '{(,ie, c< . L
rospective Adopting
0"0 u .'\~'(.....f1 ~if'J\t ~-{) ~,) ,
Prospective'-1\dol1ting Parent .-
Rev. 7/96
Page 6 of 6
{(~~ i:&~
(-2/
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~ 9?:
I DATE
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.
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0157
~OOB
ADOPTION SI'CS
-.-.. SACKS
. --~----
--
,.
,.
t ~ ~~B~!!~~P~" P~7~~~~~~~~X ~7~~~D157
PROSPECTIVE ADOPTING PARENTS CONTRACT
..
We (I), the undersigned, are interested in becoming adoptive
parents and request the assistance of Adoption Sezvices. Accordingly, we (1)
state that we (1):
1. have read and understand the Adoption Services Program Description (Rev.
5/96) and Fee and Service Schedule (Rev. 7/96);
2. state that, with the exception of the information as specifically stated
in the Program Description and Fee and Service Schedule, no promises
and/or guarantees of any kind have been made or implied to us (me) by
Adoption Services or its staff;
3. understand that we (I) will be notified of any changes ill the current
Fee and. Service Schedule that will apply to us (me) and agree to pay
Adoption Services for services rendered in accordance with the Fee and
Service Schedule that is in effect at the time the services are
rendered;
4. understand that if we (I) provide false or misleading informatior, to
Adoption Services, we (I) forfeit our (my) right to any refunds as
stated in the Adoption Services Fee and Service Schedule;
5. consent that Adoption Services and Adoption Services staff be permitted
to obtain copies of, and examine all, our (my) psychological, medical,
legal and other records and to interview all professional and lay
persons who might provide information regarding these records or provide
information related to our (my) desire to adopt a child; we (I) will
sign a release of information authorization form, as requested;
6. understand that the information given to Adoption Services as part of
the Registration, Application, Home Study processes and post-placement
Visitations, may be contained i.n \~ritten and/or verbal reports prepared
by Adoption Services and given to necessary attorneys, courta, other
agencies or government authorities as may be required. Furthermore, we
(I) understand that any and all information and records related to the
adoption process.may be admitted as courtroom evidence and that Adoption
Services may Use any and all information as part of its preparation for
courtroom testimony;
Exhibit "6"
Page 1 of 6
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15:06
'5'717 731 0157
ADOI'1'lOJ';_SI'CL _.:'" S.ICKS
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7. understand that we (I) mayor may not agree with ~art of, or all of, any
reports, statements, concluoions and recommendations made by Adoption
Services regarding our (my) desire and/or fitn,:"ss to adopt a child;
however, we (I) hereby release Adoption Services ..nd/or its staff from
any and all liability arising from information contained in their
reports and/or conclusions and/or recommendations;
.8. understand that a Home Study and/or Pre-placement Report compl"cted by
Adoption Services does not in any way guarantee that a child referral
will be made by Adoption Services or that the Adoption Services' Home
Study or Pre-Placement Report will be accepted by other private agencies
and/or local courts; and
9. agree to keep Adoption Services informed of any material changes or
anticipated changes in our (my) health or family including separation,
.marital changes, pregnancy, change of residence, change of employer and
change in family structure;
Additionally, if we (I) have
ServicGs in matchi!}g us (me) with
adoption, we (I) state that we (I):
10. . understand that in all domestic (US) adoptions at least three post-
placement visitations are required by Adoption Services and/or by state
law/regulations. Should we (I) not comply with this requirement, we (I)
understand that the placement of the child may be in jeopardy; however,
in such instances, we (I) release Adoption Services from any and all
liability therefrom.
requested the assistance of Adoption
a US-born infant/child available for
11. understand that in cases involving the placement of a chil.d, such
placement will likely take place prior to the termination or
relinquishment of the biological parents' rights. In such instances, we
(I) recognize that, prior to the termination or relinquishment of
parental rights, either biological parent may change their mind
regarding the adoption process and may request the return of the child.
We (I) also recognize that the request for return, and return, of the
child could result in emotional turmoil and financial loss to us (me),
including the loss of Adoption Services' travel fees, the birthparents'
and agency's attorneys fees and birthmother and baby hospital/medical
related costs. In such an instance, we (I) release Adoption Services
from any and all liability therefrom. Furthermore, i.n such an instance,
we (I) agree to deliver the child to the Adoption Services' office on
the date and time requested by Adoption Servites. In the event that we
(I) fail to comply with the demand to return the child, we (I) authorize
the agency to disclose our (my) identity to the natural parents and ~o
any and all other persons as deemed necessary by the agency to pe~t
the birthparents to pursue. the return of their child. Additionally, ~e
(I) agree to pay for any and all time and legal fees incurred by
Adoption Services to enforce the above;
.
Page 2 of 6
15:07
'B717 731 0157
(\.00l'T10:-:, SI'GS
-H.t S..\CKS
1i!J0IO
.
12. understand that Adoption Services asks that each birthmother and, when
possible, each birthfather complete a Birthparent Health and Genetic
History Information Form. The birthrnother is also asked to sign a
release form allowing medical information and hospital records to be
released to Adoption Services and/or its attorney. We (I) understand
that we (I) will be given copies of the Birthparent Health and Genetic
History Information Form with the identifying information removed. We
(I) understand, and fully acknowledge, that the medical infonnation
given to Adoption Services and passed onto us (me) may be incomplete or,
at times, misrepresented by the birthparents. We (I) understand that
Adoption Services does not make an independent investigation into the
birthparents' background other than to determine their intentions and
family history through interviews and conversations. Therefore, we (I)
understand Adoption Services cannot represent any and all of the risks
for the child' s health which may materialize in the present and/or
future. Accordingly, We (I) hereby release Adoption Services and/or its
staff from any and all liability arising from infonnation, lack of
information or misinformation contained in information given to us (me)
about the backgrounds and medical conditions of the birthmother,
birthfather, ,their families and the child;
13 . acknowledge and agree that Adoption Services cannot predict an
adoptive child's future including, but not limited to, emotional
and/or personality characteristics, health, medical problems,
learning disabilities, intellectual ability, hyperactivity,
attention deficits, appearance or inherited characteristics. We
(I). further acknowledge that information provided by, and through,
the Agency may be incorrect because any medical and social history
and other information obtained by the Agency has been provided by
birthparents and/or by various other sources;
14. understand that there may be occasion when all medical. bills are not
known or presented to us (me) at the time of placement. Because of
unforseen circumstances, including insurance reimbursement requirements,
any medical bills presented to us (me), even after the placement and
adoption are completed, will remain our responsibility;
.
15.'
agree to give Adoption Services the right to remove and/or
removal of the child from our family and terminate
relationship with us (me) should, prior to finalization of
such action be deemed necessary by Adoption Services;
16. agree to provide Adoption Services with pictures of, and.updates on, the
child .we (I) adopt. These pictures (at least six each time) will be
provided at a minimum of three-month intervals for the first year after
placement and at a minimum of twice per year (in December and May) for
,the next four (4) years. Additionally, unless this sentence has been
crosoed out and initialed, we (I) agree to provide a "school picture"
and update in December of each year, covering ages 5 through 18. Each
time pictures are sent, we (I) agree to provide to Adoption Services a
written update regarding the child and his/hor development. We (I)
underutand that these pictures ar.d written updates may be transmitted to
the birthparent(s). We (I) understand and agree that thio Contract,
including this section, ohal1 survive the final adoption of a child by
us (me) and shall not be terminated by an adoption decree;
recommend the
the child's
the adoption,
Page 3 of 6
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12/01/98
15:08
1S717 731 0157
AOOIYrION S\'CS
.1-1-1
S,ICKS._ _.__~011
17. understand that by accepting physical custody of a child placed with us
(me), we (I) agree to, and shall, provide all necessary care of the
child until the placement is terminated or concludes in adoption.
Should the placement be terminated for any reason, we (I) release
Adoption Services from any and all liability therefrom;
18. understand. that confidentiality is important to birthparents and to
adoptive families. While Adoption Services will take precaut\cins to
protect our (my) .identity and that of the birthparents, by our (my)
design, the birthparent's design or by some possible error on the part
of Adoption Services, the. hospital. or attorneys involved, our (my)
identity and that of the birthparents could be divulged. If such
happens, we (I) release Adoption Services from any and all liability
therefrom. Additionally, We (I) understand that, in some instances,
adoptive parents who prefer anonymity may be confronted with
.birthparents who, subsequent to placement, but prior to termination or
relinquishment, request a meeting with, or other identifying information
of, the adopting family. In such situations, we (I) agree to either
cooperate with the birthparents' request or, if so requested by the
birthparents, ~e (I) will return the child to Adoption Services;
~ .~
19. understand and agree that should we (I) violate any of the above
Contract, we (I) agree to pay any and all legal fees incurred by
Adoption Services to enforce the above and We (I) agree to pay Adoption
Services' current hourly rate for any and all time expended by Adoption
Services' staff regarding this violation;
20. understand that we (I) must comply with all of the above sections as a
condition of the agency's Consent to the adoption;
21. understand and agree that this Contract shall survive the final'adoption
of a child by us (me) and shall not be terminated by any adoption
decree.
Additionally, if we (I) have requested the assistance of Adoption
Services in matching us (me) with a Chinese-born infant/child available for
adoption, we (I) state that we (I):
22.
acknowledge that the various Governmental agencies in China to whom
we are referred are not employees of Adoption Services and,
therefore, the Agency is not responsible in any fashion or manner
for their actions; .
23. acknowledge and understand that any fees charged in the Peoples'
Republic of China, such as the donations to the Orphanage, child's
visa, etc., are to be paid.by us (me). Additionally, travel, food
and lodging are the Adoptive Parent's sole responsibility;
24. understand ilnd agree that no portion of fees paid to Adoption
Services are for legal services and/or costs in obtaining 11 US,
birth certificate, registering the adoption in a state court and/or
obta~ning United States Citizenship;
Page ~ of 6
........-f SACKS
raJOl2
. ..
25. acknowledge. understand and agree that Adoption Services is not
responsible for any foreign fees, expenses, travel expenses and/or
cost of any kind or nature. that we (I) incur in the event that an
adoption is not completed;
26. understand and agree that in the event that after placement, but
before finalization, a condition develops or is made known to ~us
(me) which causes us (me) to end the placement, we (I) understand
that no portion of the fees we (I) have paid will be refunded and
that Adoption Services shall not be responsible to us (me) for any
damages relating to the placement;
27. acknowledge that Adoption Services is not responsible for our (my)
safety and/or safety of the child at any time during the adoption
process;
28. understand that the results of any medical tests and exams for the
child will be given to us (me) but understand and agree that the
Agency does not guarantee the accuracy of these reports. We (I)
accept such risks in accepting the placement of a child;
29. . acknowledge and agree that Adoption Services cannot predict an
adoptive child's future inClUding, but not limited to, emotional
and/or personality characteristics, health, medical problems,
learning disabilities, intellectual ability, hyperactiVity,
attention deficits, appearance or inherited characteristics. We
(I) further acknowledge that information provided by, and through,
the Agency may be incorrect because any medical and social history
and other information obtained by the Agency has been provided by
the birthparents and/or by various other sources;
30. understand that by accepting physical custody of a child placed
with us (me). we (I) agree to, and shall, provide all necessary
care of the child until the placement is terminated or concludes in
adoption. Should the placement be terminated for any reason, we
(I) release Adoption Services from any and all liability therefrom;
31. understand and acknOWledge that if a condition arises after the
finalization of the adoption, the child is ours (mine) and cannot
be returned to Adoption Services and/or Chinese authorities. We
(I) accept such risk and agree that Adoption Services shall not be
responsible to us (me) or to our (my) child for any damages
relating to any condition;
32. understand and accept all the risks involved and we (I) will accept
our (my) adoptive child and hold the Agency, its Directors,
facilitators, officers and employees harmless and release said
Agency from any claims or liability;
33. agree that in the event that we (I) file any claim or action
against Adoption Services, without regard to the results, we (I)
agree to pay Adoption Services all cost it incurs in defending our
(my) claim.
Page 5 of 6
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12/01/98 15: 10
'5'717 731 0157
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1j!J013
ADOPTIOI/ SI'CS
.
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We (I), the undersigned, have read the above Contract and/or it has been
read to us (me) nnd We (I) understand and agree to all its provisions.
u J; /)(1 17
cjL( j~ / i ":JiJ;tL.iLC.~t1L
Prospect~ve Adopting Parent
1.0-,?J~? 1
DATE
. rYY-, 'l" Iv.. @.V\ L.A./~-
Prospective Adopting Parent
2 -2)- '17 .
DATE
Rev. 7/96
/
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Page 6 of 6
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SMIGJi;1.., ANDgl~SON & SACHS
ATTORNEYS AT LAW
LEROY SMIGeL
C. LEE ANDERSON
STUART S. SACKS
,JOHN W. FROMMER
,JOSEPH e. D'AMICO
ANN V. LEVIN
HEATHER D. ROYER
ERIC M. MORRISON
2917 NORTH FRONT STREET
HARRISBURG, PENNSYLVANIA 17110-1223
[717J 234-2401
FAX 17171 234.3611
'4'ttf~2-1
March 24, 1999
FOR PROFESSIONAL SERVICES:
Aug. - Sep. 1998 Phone conferences with client; review and research 150.00
regarding enforcement of contracts; diversity of
jurisdiction.
Nov. 1998 1.2 Preparation of Complaint. 190.00
Dec. 1998 Rcsearch equity issues; correspondence regarding 135.00
filing and service.
Jan. 1999 .8 Phone conferences regarding service issues 128.00
Feb. 1999 1.4 Preparation of correspondence regarding judgment; 224.00
phone conferences with Sheriff.
Mar. 1999 1.3 Phone conferences; preparation of Motion for Default 240.50
Judgment.
Filing, service costs 178.50
TOTAL S 1,246,00
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4821-2-I/CLA/tkclRulc III Show (';msciMay 211, 11)1}1} I :~-' I'~l
ADOPTION SERVICES, INC.,
PLAINTIFF
IN THE COURT OF COMMONS PLEAS
CUMBERLAND COUNTY,
PENNSYLVANIA
V.
NO. 98-7091
MAURICE G. BLANCHETTE and
FRANKIE SUE BLANCHETTE,
Husband and wife,
CIVIL ACTION -- EQUITY TERM
DEFENDANTS
f:ErnIFICATE OF SERVICE
I, Stuart S. Sacks, Esquire, herehy certify that a true and con.ect copy ofa Motion for
Default Judgmcnt and Rule to Show Cause issued April I, 1999 were served upon the following
as addressed below by depositing the same in the United States Mail, first class, postage prepaid,
at Harrisburg, Pennsylvania on April 19, 1999:
Maurice G. Blanchette
Frankie Sue Blanchette
8105 Bear Hill Road
Royse City, TX 75189
SJ\IIGEI., ANDERSON & SACKS
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Date: ~-:!f'L___
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Slu:1I1 S. Sacks, ESl.Juire
J.D. il: 1805')
2')J 7 NOrlh Front Street
IlalTishurg, P A 17110
(717)2)4-2401
Attolllcys for Plaintiff
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ADOPTION SERVICES, INC.,
PLAINTIFF
IN THE COURT OF COMMONS PLEAS
CUMBERLAND COUNTY,
PENNSYLVANIA
V,
1'10.98-7091
MAURICE G. BLANCHETTE and
FRANKIE SUE BLANCHETTE,
Husband and wife,
CIVIL ACTION - EQUITY TERM
DEFENDANTS
ORDER
AND NOW. _~/f) ,,1999, upon consideration of the within Motion to
Make Rule Absolute, it is hereby ORDRED and DECREED that 1) Defendants pay the Plaintiff
the sum of One Thousand Two Hundred Forly-six and 0011 00 Dollars ($ 1,246.00) for attomeys'
fees and costs incurred in bringing this action and 2) Defendants providc picturcs of and updates
about their adopt<'d children to the PlaintilTin accordance with paragraph 17 of their Prospective
Adopting Parents' Contract datcd August I 1,1997,
BYTHECO~
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48~1.2.I/ClN(kclRulc to Show Cause/l~'olrch 2~, It)')<} 11:46 AM
ADOPTION SERVICES, INC.,
PLAINTIFF
IN THE COURT OF COMMONS PLEAS
CUMBERLAND COUNTY,
PENNSYLVANIA
V.
NO. 98-7091
MAURlC!: G. BLANCHETTE and
FRANKIE SUE BLANCHETTE,
Husband and wife,
CIVIL ACTION - EQUITY TERM
DEFENDANT
JWLE TO SHOW CAUSE
AND NOW,.
1999, upon consideration of the within Motion for
Default Judgment, a RULE is hereby issued on Defendants to show cause why the relief
requested by the Plaintiff should not be granted.
Rule returnable
days from service
BY THE COURT,
J.
" " ,/".' . -' ,..., " '. . ,'.,' '.- " " ' " '.,'
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.
~R21.2.I/CLA/lkc/Mulion III Make Ruk Alhlllull,l ~Ia)' ~7, 1'1'l11,1 .In 1'\1
ADOPTION SERVICES. INC..
PLAINTIFF
IN TilE COURT OF COMMONS PLEAS
('IIMIIERLAND COUNTY.
PI'NNSYI.VANIA
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V,
NO. ')~. 7()')J
MAURICE G, Bl.i\NCI Wl.lI': and
FRANKIE SUE BI.ANCIII;lTI,
Hushand allll wi Ie,
('IVII. M'TION EQUITY TERM
IlI'l'FNI lANTS
M()]10.lS,T.Uj~J.A":E IHlLE ABSOLUTE
NOW ('( )~lI'.S Ih,' PI.ilnlill A<luptli\ll S~lyi,,~s, In"" hy and through its auomeys.
Smigel. Alllkrson 8:. Sack" allllnlak.." llil' lilllowing Mlllion~
I. ( hi \ \;11 ..II .~l1, I")')'), Plaintiff likd a r-,.lotion for Default Judgment
l~qn~stll1r IlIalllil' ('01111 olll<'llhl' I kkndants tlltake certain action required of them
pursuanl hI an ;\I'll'I'lnl'lll d'lll'd Jllly ~ I, I')l)(" A ~opy orthe Motion for Default
.1l1dglll~nl, Il1dn<lllll' I" I' \hihns. is atla~lied her~to,
1
()III\1'11I I. 1')1)1). Ihis Cour! ent~ll'd a Rule to Show Cause pursuant to the
alill"lIIl'nlllllll'II \llIlllIn"lI Ikl;lIi1tJudgl11~nt requiring the Defendants to show cause
II hy 111l' 1l'1Il'11 I:qlll"lL'd hy 11i~ PlailllilT should not he granted. The Rule was retumable
Ihilly 13111 days h'lIll "'1\il'~.
.1. ,\ Irue and wlTeet wpy of the Motion for Default Judgment and Rule to
ShOll ( "ill'," 1\l'I" serl"" on the Dcf~mlants hy ordinary mail on April 19. 1999 as
.... "klln.d hy Ihe ( '''lli licale or Servicc liled.
,I OWl Ihirty (~()) lbys have passed sinee the timc Dcfendants were served
II Ilh a :>'10111111 ilnd Rule III Shllw Cause. amino r"sponse has been filed or received.
',r' :'
., ,~
WHEREFORE, Plaintiff prays that this honorable court entcr an order making the Rule
absolutc, and
A. Rcquiring Dcfcndants to providc picturcs of and updates about their
adopted ehildrcnto thc Plaintiffin aecordancc with paragraph 17 of their Prospective
Adopting Parcnts' Contract.
B. Rcquiring Defcndants to pay Plaintiffthc sum ofOnc Thousand Two
Hundrcd Forty-six and 00/100 Dollars ($ 1,246.00) for allomeys' fecs and costs incurrcd
to date in enforcing thc parties' contract.. or such higher amount as may cvcntually be
incurrcd as a result of cnforcing said contract.
Rcspcctfully submillcd,
Dale~ 17 ?~r .'- 7 i rY('1
SMIGEL, ANDER~pN & SACKS
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'cC 1 . L,~.41(L-
C. L,te . nderson, Esquirc
1.0. #:21315
2917 North Front Strcct
HalTisburg, PA 17110
(717) 234-2401
Attomcys for Plaintiff
, ' : .... .. ,. ~,.' " .:~ ~ ~. ~.. " . " \. " " r '.' - .. " "__ . . : " '~.' , ':. . ' ',\ ,: .. - ,',' .
, "
CERTIFICATE OF SERVICE
I, C. Lee Anderson, Esquire, hereby certify that a true and correct copy of the forgoing
Motion to Make Rule Absolute \Vas served uponlhe following as addressed below by depositing
the same in the United States Mail, first class, postage prepaid, on May 27, 1 <)<)<)~
Frankie Sue Blanchette
8105 Bear Hill Road
Royse City, TX 75189
Maurice G. Blanchette
8105 Bear Hill Road
Royse City, TX 75189
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C. LeoAJ'ulerson, Esquire
!.D. II: 21315
2917 North Front Street
Harrisburg, P A 17110
(717) 234-240]
Attorneys for Plaintiff
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4821-2.1/CLAltkc/Motion for Default JUlJo",cntl ~lJf~h 24. !IN') 2:07 PM
,.
ADOPTION SERVICES, INC.,
PLAINTIFF
IN THE COURT OF COMMONS PLEAS
CUMBERLAND COUNTY,
PENNSYLVANIA
V.
NO. 98-7091
MAURICE G. BLANCHETTE and
FRANKIE SUE BLANCHETTE,
Husband and wife,
CIVIL ACTION - EQUITY TERi\!
I:, ":'
DEFENDANT
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NOW COMES the Plaintiff, by its attorneys, Smigel, Anderson & Sacks, andu13kes'the-<
MOTION FOR DEFAULT JUDGMENT
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following Motion pursuant to Pa. R. C. P. No. 1037(c):
1. This action was commended by Complaint on December 16, 1998. A copy of
said Complaint is attached hereto as Exhibit "A".
2. The Complaint was served on the Defendant Maurice G. Blanchette on December
30, 1998, and was served on the Defendant Frankie Sue Blanchette on Febmary 17, 1999.
3. On March II, 1999, each Defendant was served a Ten (10) Day ~otice pursuant
to Pa. R. C. P. No. 237.1 and 237.5.
4. Defendants have failed to respond to the Complaint and/or the Ten (10) Day
Notices.
5. Plaintiffs have already filed a praecipe for a default judgment for liquidated
money damages.
6. Plaintiffs Complaint also requests that Plaintiff be awarded reasonable counsel
fees to enforce its contract with Defendants.
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,
7. Plaintiffs Complaint also requests that Defendants be ordered to provide pictures
of and updates about their adopted childrcn to the Plaintiffin accordance with Paragraph 17 of
their Prospective Adopting Parents Contract.
8. Pa. R. C. P. No. 1037(c) provides that "In all cases, the court, on motion ofa
party, may enter an appropriate judgment against a partyupon default or admission."
9. Plaintiff, to date, has incurred additional costs and attorneys' fees totaling One
Thousand Two Hundred Forty-six and 00/100 Dollars (S I ,246.00), as evidenced by the attached
statement marked Exhibit "B",
WHEREFORE, Plaintiff prays that this honorable court enter an order:
A. Requiring Defendants to provide pictures of and updates about their adopted
children to the Plaintiff in accordance with Paragraph 17 of their Prospective Adopting Parents
Contract.
B. Requiring Defendants to pay Plaintiff the sum of totaling One Thousand Two
Hundred Forty-six and 00/100 Dollars (SI,246.00) for attorneys' fees and costs incurred to date
in enforcing the parties' contract; or such higher amount as may eventually be incurred as a
result of enforcing said contract.
C. Granting such other relief as the court deems appropriate.
Respectfully submitted,
Date~ 111{/...(r,t, )8 1'(1.7
S:\IIGEL, :NDid-RS N & SACKS
/ '7.
, ? ./ I 1___
C. L' e derson, Esquire
J.D. #: /21315
2917 North Front Street
Harrisburg, PAl 7110
(717) 234-240 I
Attorneys for Plaintiff
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~821.2.1/ComplaLnt/SSS/3CP 12/03/98 4:1~pm
IN THE COURT OF CO~IHON PLEAS
CUHBERLAND COUNTY, PENNSYLVA.."lIA
!? .. :r.. --1,._
NO. (1S'- 709/ ~ ,~
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CIVIL ACTION - IN EQQ...I.:~.L.Y.. C' .tiy
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YOU P.AVE BEEN SUED IN COURT. If you wish to defend ~aiilst The
claims set forth in the following pages, you must take action within
twenty (20) days after this Complaint and Notice are served, by
entering a written appearance personally or by attorney and filing in
writing with the Court your defenses or objections to the claims set.
forth against you. You are warned that if you fail to do so the case
may proceed without you and a judgment may be entered against you by
the Court without further notice for any money claimed in the
Complaint or for any other claim or relief requested by the Plaintiff.
You may lose money or property or other rights important to you.
ADOPTION SERVICES, INC.,
Plaintiff
v.
MAURICE
FRANKIE
husband
G. BLANCHETTE and
SUE BLANCHETTE,
and wife,
Defendants
. . . .: I': :,.',.: . . > -'.,.' > ,.:, " \, ;'.' " - , . .~ '.." .
N
o
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E
T
YOU SHO\,wD TAKE: THIS P."'.PER TO YOUR Li'!tlYER J..T ONCE. IF YOU DO NOT
HAVE A LAWYER OR CJ.~~lOT AFFORD ONE, GO TO OR TELEPHONE THE O?FICE SET
FORTH BELO\'! TO FUll OUT WRE?E YOU CAN GET LSG."'.L HELP.
cumberland County Bar Association
2 Liberty J..venue
Carlisle, PA 17013
(717) 249-3166
NOT I C I A
Le han demandado a usted en la corte. 5i usted auiere defenderse
de estas demandas expuestas en las paginas siguientes; usted tiene
viente (20) dias de plazo al partir de la facha de la demanda y la
notificacion. Usted debe presentar una apariencia
escrita 0 en Persona 0 par abogado y archivar en la corte en forma
escrita sus defensas 0 sus objectiones alas demandas encontra de su
persona. Sea avisado que si usted no se defiende, la corte tomara
medidas y puede entrar una orden contra usted sin previo aviso 0
notificacion y por cualquier queja 0 alivio que es pedido en la
peticion de demanda. Usted puede perder dinera 0 sus propiedades 0
otros derechos importantes para usted.
--.
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LLEVE ESTA DENMIDA A UN ASODAGO INMEDIATMIENTE. SI NO TIENE
ABOGADO 0 81 NO TIENE EL DINERO 8U~ICIENTE DE PAGAR TAL SERVICIO, VAYA
EN PERSONA 0 L~lE POR TELEFONO A h~ OFICINA CUYA DIRECCION
SE ENCUENTRA ESCRITA ASAJO PARA AVERIGUAR DONDS SE PUEDE CONSEGUIR
ASISTENCIA LEGAL.
Cumberland County Bar Association
2 Liberty Avenue
Carlisle, PA.. 17013
(717) 249-3166
- 2 -
.: 4S21.2.1/Complalnt/SSS/gcp 1:2/03/9B 31S9pm
,
ADOPTION SERVICES, INC.,
Plaintiff
IN THE COURT OF CO~INON PLEAS
CUMBERLAND COUNTY, PE~rnSYLVANIA
NO. q f - 70 9/ ~I I.-L-<-
v.
~~URICE G. BLANCHETTE and
FRANKIE SUE BLANCHETTE,
husband and wife,
Defendants
CIVIL ACTION - IN EQUITY
COMPLAINT
AND NOW comes ADOPTION SERVICES, INC., by its attorneys S~l!GEL,
~~ERSON & SACKS, and avers the following:
COUNT I - SPECIFIC PERFORMANCE
1. Plaintiff is Adoption Services, Inc., an adoption agency
licensed in the Commonwealth of Pennsylvania, with its principal
office at 28 Central Boulevard, Camp Hill, CUwberland County,
Pennsylvania.
2. Defendants are Naurice G. Blanchette and Frankie Sue
Blanchette, husband and wife, whose current address is 8105 Eear Hill
Road, Royse City, Texas 75189.
3. Plaintiff provides adoption services, including intermediary
services to arrange adoptions between biological parents and adopting
parents.
4. The services of the Plaintiff were provided to Defendant
pursuant to a contract, which was executed by the Defendants at the
offices of the Plaintiff on August 11, 1997. A copy of the contract,
entitled Prospective Adopting Parents Contract, is attached hereto as
Exhibit "1".
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5. Pursuant to the Contract, the Plaintiff placed two children
for adoption with the Defendants on August 14, 1997. For purposes of
this Complaint, the children are referred to as Dylan and Daniel.
6. The two children were adopted by the Defendants before the
Cumberland County Court on November 10; 1997.
7. Paragraph 17 of the Contract requires, inter alia, the
Defendants to provide pictures and updates about the childre~ to
Plaintiff for approximately eighteen years.
8. Defendants are aware that the requirement .for pictures and
updates is a contractual requirement and is also relied upon by the
biological mother.
9. Plaintiff has made numerous and repeated requests to the
Defendants to provide the pictures and updates, but they have refused
or failed to do so.
10. Paragraph 20 of the Contract obligates the Defenda~ts to
pay, inter alia, any and all legal fees incurred by Adoption Se",ices,
Inc. to enforce the Contract.
h~EREFORE, Plaintiff prays this Honorable Court to enter an Order
requiring the Defendants to comply with Paragraph 17 of the Contract
to supply pictures and updates for the duration of the time specified
in the contract, and to pay reasonable counsel fees incurred by the
Plaintiff, together with costs.
COUNT II -IN ASSUMPSIT
11. Plaintiff hereby incorporates the averments of paragraphs 1
through 10 by reference, as if more fully set out hereafter.
- 2 -
. .
12. Pursuant to the Contract of August 11, 1997, the Defendants
have failed to pay Plaintiff, for services rendered, the sum of
$16,361.00, evidenced by the invoice dated November 25, 1996, attached
hereto as Exhibit "2" and incorporated herein by reference.
13. Despite numerous demands by:Plaintiff, Defendants have
failed or refused to pay for the services rendered as set forth in
Exhibit "2".
14. Plaintiff also placed two other children with Defendants for
which there are outstanding balances owed.
15. In 1996, Plaintiff placed a child with the Defendants, said
child known as Taylor, who was also adopted by the Defendants in 1997
before this Court.
16. There remains a balance due of $95.00 for the placement of
Taylor, as represented by the invoice attached hereto as Ex.."ibit "3".
17. Despite numerous and repeated requests by the Plaintiff,
Defendants have failed or refused to pay the $95.00 due as represented
by the invoice attached hereto as Exhibit "3".
16. In 1997, the plaintiff placed a child with the Defendants,
said child known as Dominic, who was also adopted before this
Honorable Court in 1997.
19. For the placement of Dominic, there remains a balance due of
$100.00, as represented by the invoice attached hereto as Exhibit "4".
20. Despite numerous and repeated requests by the Plaintiff,
Defendants have failed or refused to pay the $100.00 due, as
represented by the invoice attached hereto as Exhibit "4".
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21. Defendants entered into Contracts for the placement of
Taylor and Dominic, attached hereto respectively as Exhibits "5" and
II 6".
22. The Contracts for the placement of the children require,
inter alia, the Defendants to pay Plaintiff's reasonable counsel fees
and expenses to enforce the provisions of the Contracts.
WHEREFORE, the Plaintiff prays this Honorable Court to enter
judgment against the Defendants for all three contracts in the total
amount of $16,556.00, together with reasonable counsel fees and
expenses as may be awarded by the Court.
Dated:
December 7 'T.J-, 1998
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tuart'S. Sacks, Esq.
I.D. No. 18059
SIHGEL, F.NDERSON & SF.CKS
2917 North Front Street
Harrisburo, PA 17110-1223
(717) 234:2401
Attorney for Plaintiff
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VERIFICATION
I, Vincent F. Berger, Ph.D.... President of Adoption Services,
Inc., a licensed adoption agency in the Commonwealth of Pennsylvania,
verify that the statements contained in the foregoing Complaint are
true and correct to the best of my knowledge, information and belief.
I understand that false statements therein are made subject to the
penalties of 18 Pa.C.S. 54904, relating to unsworn falsification to
authori ties.
vinfl~~
~~OPTION SERVICES, INC.
28 Central Eoulevard
Camp Hill, PA 17011
Preside:1t
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Date: December
J-,
1998
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~, Adoption
, .28 Central Boulevard' Camp Hill, PA 17011 . (717) 737,3960 . FAX (717) 731-0157
Services, Inc.
PROSPECTIVE ADOPTING PARENTS CONTRACT
He (I),
parents and request
state that \-le (I):
the undersigned, are interested in
the assistance of Adoption services.
becoming adoptive
Accordingly, we (I)
,.
. .
have read. and understand the current Adoption services ~rogram
Description and Fee and Ser.vice schedule;
state that, ,with the exception of the information as specifically stated
. :in'. the Program Description and Fee and Service Schedule, no promises
and/or guarant~es of any kind have been made or iinplied to us . (me) b,Y
Adoption Services or its staff;
understand'that we (I) will be notified of any changes in the current
Fee and Service Schedule that will apply to us (me) . and agree ,to pay
Adoption Services far services rendered in accordance with the Fee .and
service Schedule that is in effect at the time .the services are
rendered;
understand that if we
Adoption Services, we
stated in the Adoption
(I) provide false or misleading information
(I) forfeit our (my) right to any refunds
Services Fee and service Schedule;
to
as
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5. consent that Adoption services and Adoption services staff be permitted
to obtain copies of, and examine all, our (my) psychological, medical,
legal and other records and to interview all professional and lay
persons who might provide information regarding these records or provide
information related to our (my) desire to adopt a child; we (I) will
sign a release .of info~ation authorization form, as requested;
6. understand that the information given to Adoption services as part of
the Registration, Application, Home study processes and post-placement
visitations, ,may be contained in written and/or .verbal reports prepared
by. Adoption Services. and given to necessary attorneys, courts, other
agencies.or government authorities as may be required. F.urthermore, we
:' '.(I) .llnderstand that .any and all information :and records relate~ to, the
'~',,' a~oPtiori process may. be. admitted :as courtroom ,e'{idence .and .that .A~option
services may. .llse any and all.information as part of. its preparatJ.on, for
courtroom testimoriy; ., . ... . , .- .::.\
Exhibit "1"
Page 1 of 6
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7. understand that we (I) mayor may not agree with part of, or all of, any
reports, statements, conclusions and recommendations made by Adoption
Services regarding our (my) desire and/or fitness to adopt. a .child;
however, we (I) hereby release Adoption Services and/or its staff from
any and all liability arising from information contained in their
reports and/or conclusions and/or recommendations;
8. understand that a Home study and/or Pre-placement Report completed by
Adoption Services does not in any way guarantee that a child referral
will be made by Adoption Services or that the Adoption. Services' Home
Study or Pre-Placement Report will be accepted by other private agencies
'. and/ or local courts; and
9. agree to keep Adoption Services informed of any material changes or
anticipated.changes in our (my) health or family including separation,
marital changes, pregnancy, change of residence, change of employer and
change in family structur~; . .
Additionally, if '.we . (I) have
serVices. in." matching :us (me) :with
adoption, we (I) st~te that we (I):
..
requested the assistance of Adoption
a US-born infant/child available. for
10. understand that in all domestic . (US) adoptions at least three post-
placement visitations .are required by Adoption Services and/or by state
law/regulations. .Should.we.(I) not comply with this requirement, we (I)
unders~and that the placement of.the child may be in jeopardy; however,
. in such instances, we (I) release Adoption Services from any and all
liability therefrom.
11. understand that in cases involving the placement of a chile., such
placement will likely take place prior to the. termination or
relinquishment of the biological parents' rights. In such instances, we
(I) recognize that, prior to the termination or relinquis~~ent of
parental rights, either biological parent may change their mind
regarding the adoption process and may request the return of the child.
We (I) also recognize that the request for return, and return, of the
child could .result in emotional turmoil and financial loss to us (me),
including the loss of Adoption Services' travel fees, the birthparents'
and' agency's attorneys fees and birthrnother and baby hospital/medical
related costs. In such an instance, we (I) release Adoption services
from any and all liability therefrom. Furthermore, in such an instance,
we (I) agree to .deliver the child to the Adoption Services' office on
_ ....the. date' and time requested by Adoption Services. In the event that we
.. (I) fail-.to comply with. the demand to return the child, we.~(I)authorize
,. the ...acjencyto disclose our (my) identity . to. the natural parents .and to
~. : : an.y,;and "all :'other ~person's ;as . de.emed necessary by the agency. to permit
.. '.::the" birth'pare.nt.s to 'pursue the return. of their: child. . Additionally, we
.: (I) . agree ;to'pay1 for'any .and. all .time and legal fees. incurred by'
Adoption Services to enforce the above; . .
Page 2 of 6
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l2. understand that Adoption Services asks that each birthmother and, when
possible, each birthfather complete a Birthparent Health and. Genetic
History Information Form. Th.e birthmother is also asked to .sign a
release form allowing medical information and hospital. records to be
released to Adoption Services and/or its attorney. We (I) understand
that we (I) will be given copies of the Birthparent Health and Genetic
History Information Form with the .identifying information removed. We
(I) . understand, and .fully acknowledge, that the medical information
given to Adoption Services and passed onto us (me) may be incomplete or,
. at times, misrepresented by the birthparents. He .(1) .understand that
Adoption Services does not make an independent investigation into the
birthparents '.. background other than to determine their intentions and
family history through interviews and conversations. Therefore, we. (I)
understand Adoption Services cannot. represent any and all of the risks
for the child's. health which may materialize in the present. and/or.
future. Accordingly,.we (I) hereby release Adoption Services and/or its
staff from any and. all liability arising from information, lack of
informatiqn or misinformation contained in information given to us (me)
about the backgrounds and medical conditions .of the birt~~other,
birthfather, ~peir families and the child;
. .
l3. acknowledge and agree that. Adoption. Se.cvices cannot predict: an :
.adoptive child' s future. including, but not. limited to, emotional.,
and/or personality:~ characteristics, health, medical.. problems,:..~
learning disabilities, . intellectual ability, hyperactivity,
attention ..deficits, . appearance or inherited characteristics. .. _He
(I) further.~cknowledge that:information provided by, and through,
the Agency may be incorrect because any medical and social history
and other information obtained by the Agency has been provided by
birthparents and/or by various other sources;
14. understand that, at the time we take custody of a child, we must escrow
anticipated birthmother and child medical fees. These moneys will be
escrowed with the agency's attorney. He (I) understand and agree that
all Inedical bills :Je paid. prior to the time of the final adoption
hearing'. Accordingly,. we (I) agree that any medical bills/charges
outstanding just before the final adoption hearing will be paid froIn our
escrow account.. We .(I).can.then, on our (my) own, continue to.resolve
any insurance reimbursement, although we (I) understand that insurance
reimbursement may not take place;
15. understand .. that there may be occasion when all medical bills: are. not
known or. presented to us (me) .at..the .time of placement .or even.at..the
time. of finalization. : .Because ~.of 1 unforeseen circumstances,. 'including
insurance reimbursement requirements, any medical- bills .presented .to. us
(me), even after the placement and adoption are completed, will remain
our responsibility. and .wei(I) ..agree .to :pay.any such medical bills:within
30 days of receipt ~f._th~ .bill(s);' .".. .:::::.....;: ~.. :. _ .;; .....
16.
agree to. give Adoption SerVices the right to remove and/or
removal; .of':: the . ,child . from.' our family and terminate
relationship with us (me) should, prior to finalization of
such action be deemed necessary by Adoption Services;
.recommend the
the ,;child's
the adoption,
..
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17. agree to provide Adoption Services with pictures of, and updates on, the
child we (I) .adopt. These pictures (at least twelve each time):will:be
. provided at a'minimum of three-month.'.intervals for the firstye.ar.,after
placement and at a. minimum oftwic.e per year (in -December and .Ha~{).'.:for
the next .four (4). years. . All pictures are to .be in .focus.'with...the
. chilp.' s features clearly visible. The pictures will be' of.' the. .same
quality as those normally included in my/our family picture album..~. The
~ updates are to be at least one page in length (approximately 250-300
word. minimum) and should .be.of a quality you would send to :'a .close
relative. . Additionally,. unless this sentence has been crossed 'out 'and
initialed, we' (I).. agree. to provide a...."school picture" and .update in
December .of each .year, covering ages.5. through l8 ... Each time .pictures
~-:aresent;~we .(1) ;agree to:provide'to Adoption services a'written update
: : . regarding ,.the . child and. his/he.r .development. . We . (I) ..understand. that
. >these' pictures ..:and. writ:ten--.updates ..may. be transmitted ,..to'(~the
. . birthparent(s)..' :' He ::..(1) .. un~erstand .and agree that. this. Contract, .
. . including .this'section,..'shall . survive the final adoption .bf a 'child by
us (me) - an~. s.hall no~.be ~e:=mi.~a.::~d by . an adop~~on decree;. ..
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18. understand that'.by accepting physical :custodyof a child placed with us
(me.), we (I) agree to, and shall, provide all necessary care of the
child until. the - placement is.' :terminated' or concludes . in . . adoption.
Should .the placement be' terminated'.:fo.r any :reason, .we (I). .r.elease
Adoption. Services'.. from ary.y:and .all liability. therefrom; . . .
\ '~-..'. ..... - ~ '
19. understand that.. confidentiality. is important to birthparents. and to
adoptive - fwlies. . vlhile Adoption. Services will take pre'cautions to
protect our (my) identity and that .of. the birthpartlnts, by our '(my)
design, .the birthparent's design 'or by some possible error on,the part
of Adoption services, the hospital or attorneys involved, our (my)
identity and that of the birthparents could be divulged. If such
happens, we (I) release Adoption .Services from any and all liability
therefrom.' Additionally,. we (I). understand that, in some instances,
adoptive parents who prefer anonymity may be confronted . with
birthparents who, subsequent 'to placement, but prior to termination or
relinquishment, request a meeting with, or other identifying information
...of, ,.the.c,dopting family.: .In .such.situati.ons, we.(I) agree to',either
:: cooperate with the birthparents' request or, if so. requested .'by :,..the
birthparents, .we (I) will .return the child to Adoption Services; {~,.
20. understand and agree that should "Ie (I) violate any of the above
Contract;.:we..;(I).. agree :to pay. any. and :all legal. fees ..incurred by
Adoption Services :to,enforce:the;above.and we (I) .agree to pay'Adoption
..;-: .services' ,'.current .hourly. rate".for 1any ..and :.all time -expended by JI.doption
:~ ~ .Services'. s~aff ..regii.rdihg ~this . violation; i?:; ,;:~,;.~:, ,...."..,:. - ",.;:::\~.u:::~~ r.
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21.' ;',~lindei6tand r-thil.t .:we ,,( I) '.l1\ust "f=omply..,with JaIl ',of I..the 18DOVe : sections ;r.as a
cond~ti?n of.U~e'llgenc;Y"s Consent .:t6.lthe'.adoptioni ,.:,;:',1:1:>: 7,.;'~i'~.l:.),t
" '.. ::.. .......~.:.. ...'::.'.'.;'.: ::,.y.:...':.:....,. :.;... .. ..,... . ,." " . ':;..'.:....
22. ~ understand "and :agree '.that .this JContract :5hall survive :the 'finaladoption
. ':' 'of. a .child ~ by. us: (me) and ".shall :not : be terminated' by ':any ".'adoption
..~~decree .14 :". ro.......... ;~...:.~ .... ......... f........t, / .". ., ,'-to r:1.~:",,-.-J...l.....-.
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:" Additionally, if we (I)
Services'. 1n :...matching.' ',us (me)
Pridnestr.ovie~bo.rn.' or Russian.-born
(I) stafe that we. (I):
,.
have requested the assistance of:Adoption
. 'with' a . :Chinese-born, ,)loldova'-born,
infant/child available for. ~d~pti~n, we
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23. acknowledge. 'that. the various ,Coordinators .andGovernmentClY.."agencieis
in'the. foreign' c.ountry. to.'whom w'e are ,'referred are ;not employe.es. ~of
Adoption .Services . and;: therefore',. ..the. Agency' is .not resporisible-:in
anY.Jas.l!iot\~.~r~.m,~ime1=~.OF...thei.r .!3-.6,H,on~;:" . .~. ,. ..' ....:..-' .. .
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24. acknowledge and understand that any fees charged in, and/or by, the
fore~gl}." c9)l)1try, sucl}...il-s ..t~e. d9natio~s: t9 t.he. Orph~nage, '.. ch.ild.'. s
vis~, ;~tc::.!,:ar.e. ,to ,be.paid by .us. (me). Adcg1;:ionally, .travel,;food
and .lodgip.g ..are th~, Ac;ioptive ,Parent ~ s. sole .J;.esponsibili ty i ,~: : ~.
. . .... .',' ,. ~.
25. understand and agree that no portion 'of fees paid. to JI.doption
Service~ ~re, fgr, legal :i,s.~rvices .2.nd/o.r:. cqsts ;, in' . obtaining. a. us
birth certific.a~e, ~egisterip.g ,the.ad9ption:in.a.stat~ court and~or
ob~.ain~ng Unj,ted state~..Citi.z~t}~l.!ipi., :,'-.':.~."~,.:. .:-:..::0....:::;:-'. ;> : :i. ~,"'..
\.
26. aCknowiedge., understand and agree that .lI,doption Services is not
responsible for any foreign fees, expenses, travel expenses and/or
cost .of any~kind or..nature.,that we (I) il}cur...in the event that an
adoption .is :not .comp~eted~.: .. __ ' ,.. . ...
27. understand and agree that in the event that after placement, but
before finalization, a condition develoos or is made known to us
(me) which causes us (me) to end the. placement, we (I) understand
that no portion of the fees we (I) have paid will be refunded and
that Adoption Services shall not be responsible to us (me) for any
damages relating to the placement;..:: ...' ,., .:.. -.
28. acknowledge that Adoption Services is not responsible for our. (my)
safety and/or safety of the child at any time during the adoption
process;
29.
. ~ . . .' .
understand that the results ....of any. me'dical ~est.s and ;exams for the
child will.'be'-given 'tous'-(meL,:but .u.nd~r5tana.~ahd ';agree, that the
Agency does not guarantee the accuracy of these reports. We ' (I I
accept s~ch risks in~ccepting the.placem~~t of 2. child;
acknowledge . and :. agree ':;'th~(';Ad~pt:ion ..s~;Vice{. canilot :p~'e'dict;:.:aii
adoptive .child '.s . future. including ;.;. but ,.not.: limited .;to, .:; emotional
and/or personality'characteristics, health,., .lnedical.' .problems,
lear~ing ,~.:.d~s,a~il~~tii~~'~:;';:l~n~el,l~~b.1~l.::...abi!.~tY'i .::.: hyp~ra~~~vi_~y,
attention .;def~c~ts I :,appearance ~ or J inher~ted 'characteristics ..~'.c.We
(I) .furthe.r' acknowledge that' information provided by, and through, L'
the Agency may be incorrect because any medical and social history:
and other information obtained by the Agency has been provided-by
the birthparcnts and/or by various other Gources;
_, j; ,j ;"'.:' t .l
30.
Page 5 of 6
1 _ '~. . . ". _ . . '.,_ - -\ -: ,.' ," . . . "'" ' " , . ,r " \. . : ~, '.' ) , ". ,
t'!.. _..
31. understand that by accepting physical custody .of a child ,placed
. with. us (me"),' we' (I).' agree to, and' shall, 'provide ,alF'.rieces,sary,
care of the child ~ntil the placement is terminated.or'concludes in ,.
adoption: . Should .th~ placement be 'terminated' for aiW, i'cason, we'
(I) release Adoption Services from any and all liability ther'efrom'i'
32. understand and acknowledge that if a condition arises after the
finalization of the adoption, the child is ours (mine) and,cannot
be 'returned 'to" Adoption "Services 'and/or 'the ~ authi:;rities, from' the
foreign colin'try 'from' which the' child .\;;a:s' aCiopted;'::'l'le':;(I)"ac6ept
such risk and agree "that Adoption Services 'shall':not"be'responsib1e
,to us (me) or to our (my) child for 'any damages relating to' 'any'
condition; .
.: -.:; ,\.";! '!u\::'::~; ,~i.: .::~: '~~..:.~. :".: :.. '."Z .: ~-" :...:..~.~~._.-.. '...-;is ...::.:.. ....
33. understai1d ahd' accept 'all theiisks 'iilvolvE)d 'and 'we (I): will, <;-ccept
our '~'(my) ,': adoptive child. 'and hold. the rAgeincy, =,'its 'Direcj:ors~
facilitators, 'officers' 'and: employee's' 'hai:ID1.ess 'and release"':'said
Agency from any claims or liability;
...~~.'::"."".,-,<-,,: i.'; ~:,':.2;r.:: ::.~.:.:= ::.; ::~:...:,/_.:c ~:..::.. _............ ':":;''3 ..-----_.
34. agree' that. in"th~ ': event' that" we (I). 'file 'any' claim '"Or action
against Adoption. Services,:'without.'~regard 'to :the re'sults,':'we (I)
agree to pay Adoption Services all:cost~it 'incursin'defending our
(my) claim.
.. .....
. .' .
. ,'~' - .'
..' '>,":n:'::.
.~ ..~ . . .
": .:
. ~. _..
- '. . ~. .
He '(I)" the' undersigned, have .readthe"above~Contrict'a'n6./o'!:' it has
been read to us (me) and we (I) understand and agree to all its provisions.
ryT)
, '<'if!;) iu
Prospective Adopting
:. 'J ~
. .
..
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t:~.: ':
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Prospective'l\dopting Parent.,",'l; <,J ','.. .,.'J;,,:, ..;'
.~..f... ~.. ....~ .. ". ._:'..:::..:.. ..:.:J ':':';~'.~t;;:a:'I:..1 '().~ ,".;".:':~
. :".
~ I. '... j::-. .;.. ~.) :.::: . : oJ :. ~.. .' -r L : . "..": ~ . : -;.::. ..:.:. ::: ;c' ~~ r. ~ d '~Uc..'
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I~f;'l'" ~'~....,.!) ('J 1:~--t ".1... r ....,,-. .t(.,.l' ";...:.(..;r...;.;~ "~.",u'~v';\ ;5'1:. "~..'~, ..r.....-._.~'..
". ..l.,...."... ,.... ..... ''''..t .... "- \F "-"" .;... ~.. ~ ... .' .-..~...-.4~.:.~..-."':..I.4.
\'~I;::.J':':;"..-: lL:;'.f.:..~j:I e. ~..J !-J::"": ,c'.)L.1~1.:J~lj~r).,.~(~:" \::t~.If"I(,:'.=~'':')1 a:"\~~.I"':~
,'.:j.':lJ'."_.:',1';~, "iJ~~ild.~ ,1/ju~~!;)rl!):h1.i:-'!' .,e'~.!.1.i:I.Jd';.::"U",", t:::h,.i"r,,.....r
.,;,; .. .'~~: ~ ~ ~ ,:':,;; .': : :!:,~:J /,;.;i :,",: -;''::1j,).,~ . t'l:)nr.:r~::r:lqn '"..; '~:1,bl 't",fJ, c:(l11(1;;:~j c
Rev. 6/V;;~';~ t.::.. ,'le: !,<::.;,:.., ,..:.It':l.:i.': ,J,:t!J Oi?b~\oJoi~x::>r" 7.:.ortJ:..u.~',I,ri
papc.a.s~j~ [:::'.:"'~ ',:.,,: :..::.,:_ .....: \...... :;:'~.' ...0: .:1";'~''J.IOOfiLt.r.; \:.l..:, ~i:;(;'J..'\ (,.,',
y. ..:J..:.......i.:.'~~ ~:.:_'':' 2.:< .....:.,.~.~,.~:. ~..~:: ":_: ,!.:'..:'': ~:, ~.:.."..~~.':7'";'~~:'~~. '';:'/.,~' r...
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Page 6 of 6
, .
.11/24/98 13:08
~717 731 0157
ADOPTIO:'/ SVCS
~ H SACKS
1ilJ004
. , . '.".' .";. .~"T" , . : ' '::' '. -, "".' . _, - '." ," 1, _ " . '. ' .. . '. -'.. .,.': --',' . '. _ ' , .: ' ' -:-', ".":,:
f ' .\
Adoption SerVices, lnc,
, '
28 Cenlral Blvd,
Camp HiU, PA 17011
~ il-J
Statement
DATE
111"'...5198
TO:
Mo &. FrJnkie B1J.acbettc
810S Beu H111 Ro.d
Roy,e Cil)l TX 75189
AMOUNT DUE A.\lOUNT ENe,
516,361,00
DATE I TRANSACTION AMOUNT 8A!..A.'JCE ,
12/31/95 Bal.""" !ol"llord 0,00
08/13/97 INV N56C4 975,00 975,00
08/13/97 PM'!" #1879 -575,00 0,00
08115/97 L'I\' N5610 1,350,00 1,350,00
08115/97 L"lV #S6l! 405.00 1,755,00
08(27/97 [NY N5632 13,150,00 14,905,()()
11107/97 INY #S758 1,200,00 16,105,()()
11/08/97 [XV #5760 2()(),OO 16,305,()()
11/14191 1.'1\' N5768 56,00 16,361.00
CURRENT 1.30 DAYS PAST 131'60 DAYS PAST 16f:90 DAYS PAS' OVER 90 DAYS M~OUNT DUE
DUE DUE DUE PAST DUE
0,00 000 0,(10 000 16,361.00 Sl~.36I.oo
I I
Ex11ibit "2"
.'_r1".~_..-.:.., ":L..- J ..-
11/24/98 13:07
~717 731 01S7
^DOPTl ON S\'CS H' SACKS
IilJ 002
Adoption ServiCes, Jne,
28 Central Blvd,
Camp Hill, PA 17011
r&.~~ t1 /
Statement
DATEa
11/'25/98
TO:
B13.nchcUC, ~h.urict &. Ft:lnkJe
8105 Bear Hill Roed
Roy" City TX 75189
AMOUNT DU~UNT ENC, I
595,00 I
DATE TRANSACTION AMOUNT BAl.ANCE
12f.l1/95 Bal,nee forwud 0,00
05/17,<)6 INV 14889 - 475,00 475,00
05/17/96 PMT U1303 -475,00 0,00
06112J'J6 INV U4933. 5,00 5,00
0li/13,')6 p~rr # 11727 .5,00 0,00
07/10/96 L'N /1-1999 . 20S0 20.50
07110,,)6 INV U5oo2 . 3,275,00 3,295.50
07/11,<)6 PMT #1372 -3,295.50 0,00
08/02/96 INV #5057 - 1,140,00 1,140,00
09104,,)6 PMTRI454 -1,140,00 0,00
10,112/96 ll'<'Y 15170- 190,00 190,00
11/01/96 INV #5215. 1,615,00 1,805,00
01/20m PMT #1636 -1,822,00 -17,00
0411121')7 ll-<'Y 15410/11 13,017.50 13,000,50
04,1)21')7 L'N #5412 68,36 13,0li8,86
06.1)2/97 p~rr 13297 .13,068.86 0,00
~106fn IN\' #5483 95,00 95,00
CURRENT 1~Ol)AYSl5ASr-31'60 DAYS I"'A:>I 161'90 DAv$l5ASr OVERSO[}A'(S AMOUNT DUE
DUE DUE DUE PAST DUE
0,00 0,00 000 L 000 95.00 1?5,oo
EYw'Jibit "3"
11/24/08 13:07
~717 731 0157 ____
ADOPTIO;'; SI'CS
..... S.\CKS
!ilJ 003
Adoplion Services, Inc.
, ,
28 Central Blvd.
Camp liiII, PA 17011
tZur~ rf-J.
, Statement
DATE
11l25m
TO:
~butio: &: Frankie BI"Ch,t<c
8108 Ikor Hill Road
Royse City TX 75189
AMOUNT DUE AMOUNT ENC,
S 100,00
DATE TRANSACTION AMOUNT BALANCE
.
I 2J3 1195 B3Janc: forward 0,00
0']J24/97 INy #8356 975,00 975,00
0']J24/97 P~IT #1525 ,975,00 0,00
031U197 4'N #5391 427.50 427.50
03126197 !NY #5392 1,235,00 1,662.50
03126197 INy #5393 190,00 1.852.50
03126/97 INV #5394 190,00 2,042,50
04:011197 !NY 1IS422 6,295,00 8,337.50
07/31/97 PMr #1876 -8.337.50 0,00
07f31r;7 INY N5585 1,1.~O,OO 1,140,00
08,\)5/97 P.o."V N5598 43,79 ],]83,79
09/29/97 nIT #194-1 -1,]83,79 0,00
IOi1l2/97 INV #8698 100,00 100,00
CURRENT 1-30 C'"VS PAST 31-60 DAYS PAStl'90 DAYS PASTI OVER 90 D~YS AMOUNT DUE
DUE DUE DUE PAST DUE
0,00 0.00 000 I -~--;oooo $100.00
. --1___
Exhibit
II"'''
"
15: 01
'B'717 731 015.1....-_ ADOPTIO); SI'CS
..< S.\CKS
QJ 002
,
- -----.------
7( ;llf 1(,
t ~ ~~B~~!!~~r. P~7~~~~~~~:'X ~7~~I~or57
PROSPECTIVE ADOPTING PAREN~S CONTRACT
.. '
.
He (I),
parents and request
state that we (X):
the undersigned, are ..interested in becoming adoptive
the assistance of Adoption Services. Accordingly, We (X)
1. have read and understand the Adoption Services Progra~ Description (Rev.
5/95) and Fee and Service Schedule (Rev. 7/96);
2. state that, with the exception of the information as specifically stated
in the Program Description and Fee and Service Schedule, no promises
and/or guarat:ltees of any kind have been made or implied to us (me) by
Adoption Services or its staff;
3. under'stand that we (I) will be notified of any changes in the current
Fee and Service Schedule that will apply to us (me) and agree to pay
Adoption Services for services rendered in accordance with the Fee and
Service Schedule that is in effect at the time the services are
rendered;
4. understand that if We (I) provide false or misleading infonr.ation to
Adoption Services, we (I) forfeit our (my) right to any refunds as
stated in th~ Adoption Services Fee and Service Schedule;
5. consent that Adoption Services and Adoption Services st~ff be permitted
to obtain copies of, and examine all, our (my) psychological, r.:edical,
legal and other records and to interview all professional and lay
persons who might provide information regardi~g these records or provide
information related to our (my) desire to adopt a child; we (I) will
sign a release of information authorization form, as requested;
6. , understand that the information given to Adoption Services as part of
the Registration, Application, Horne Study processes and Post-placement
Visitations, may he contained in written and/or verbal reports prepared
by Adoption Services and given to necessary attorneys, courts, other
agencies or government authorities as may be required. 'Furthermore, we
(I) understand that any and all information and records related to the
adoption process may be admitted as courtroom evidence and that Adoption
Services may Use any and all information as part of its preparation f.or
courtroom testimony;
Exhibit "5"
Puge 1 of 6
""-.-, -,' -. -,.. -.'-, ~-,-~
, - '.'V"~~,."~~,.;r;;~~...'-;~-"~,.~...,-:,,~,,",---,, ',; '1...A'"~_.;!"~'-~',l, '....,,- ". ,_ .
"
15:01
7Jl 11.157
ADOPTION S\'CS
'H., S,\CKS
~OOJ
- -----
.
7. "O,."t,o' th,t wa "I may 0' rooy oot ng", with ",t of, 0' nl' of, aoy
reports, statements, conclusions and reconunendations made by Adoption
Services regarding our (my) desire and/or fitness to adopt a, child;
however, we (I) hereby release Adoption Services and/or its staff from
any and all liability arising from infol:n1ation contained in their
reports and/or conclusions and/or recommendations;
,. """mt,o' that , a.., """y '0'/00 Pro'Pl.".,,, "po", oompt,t" by
Adoption Services does not in any way guarantee that a child referral
will be made by Adoption Services 01;. that the Adoption Services' Home
Study or Pre-Placement Report will be accepted by other private agencies
and/or local courts; and
9. agree to keep Adoption Services informed of any material changes or
anticipated ..changes in our (my) health or family inclUding separation,
marital Changes, pregnancy, Change of residence, change of e~ployer and
change in family structure;
Additionally, if
Services in matching
adoption, we (I) sfate
we (I) have
us (me) with
that We (I):
requested
a US-born
the assistance of ,/l,doption
infant/child available for
10. ,.understand that in all domestic (US) adoptions at least three post-
placement visitations are required by Adoption Services and/or by state
law/regulations. Should We (I) not comply with this reqUirement, we (I)
understand that the placement of the child may be in jeopardy; however,
in Such instances, we (I) release Adoption Services from any and all
liability therefrom.
11. understand that incases inVOlVing the placement of a child, Such
placement will likely take place prio:::- to the termination 0:::-
relinquis~r.,ent of the biological parents' rights. In such instances, we
(I) recognize that, prior to the termination 0:::- relinquis~~ent of
parental rights, either biological parent may change their mind
regarding the adoption process and may request the return of tr:e child,
We (I) also recognize that the request for return, and returr., of the
child could result in emotional turmoil and financial loss to us (me),
inClUding the loss of Adoption Services' travel fees, the birthparents'
and agency' s attorneys fees and birthmother and baby hospital/medical
related costs. In SUch an instance, we (I) release Adoption Services
from any and all liability therefrom. Furthermore, in such an instance,
we (I) agree to deliver the child to the Adoption Se~yices' office on
the date and time requested by Adoption Services. In the eVent that we
(I) fail to comply with the demand to return the child, we (I) authorize
the agency to disclose our (my) identity to the natural parents and to
any and all other Persons as deemed neCessary by the agency to permit
the birthparents to purSUe ~he return of their child. Additionally, we
(I) agree to pay for any and all time and legal fees incurred by
Adoption Services to enforce the abOve;
.
Pag'.! 2 of 6
12101/08
'&717 731 0157
^QOPTIO~ S\'CS
....... SACKS
li!J 004
15:02
12. underatand that Adoption Services asks that each birthmother and, when
p05oible, each birthfather complete a Birthparent Health nnd Genetic
niatory Information Form. The birthmother i5 also 'asked to sign a
release form llllo'",ing medical information and hospital records to be
released to Adoption Services and/or its attorney. We (I) understand
that we (I) will be given copies of the Birthparent Health and Genetic
History Information Form with the identifying information remov~d. We
(I) understand, and fully acknowledge, that the medical information
given to Adoption Services and passed,onto us (me) may be incomplete or,
at times, misrepresented by the birlhparents. We (I) understand that
Adoption Services does not make an independent investigation into the
birthparents' background other than to determine their intentions and
family history through interviews and conversations. Therefore, we (I)
understand Adoption Services cannot represent any and all of the risks
for the child's health which may materialize in the present and/or
future. Accordingly, we (I) hereby release Adoption Services and/or its
staff from any and all liability arising from information, lack of
information or misinformation contained in information given to us (me)
about the backgrounds and medical conditions of the birthrnother,
birthfather, :their families and the child; ,
13. acknowledge and agree that Adoption Services cannot predict an
adoptive child's future including, but not limited to, emotional
and/or personality characteristics, health, medical problems,
learning disabilities, intellectual ability, hyperactivity,
attention deficits, appearance or inherited characteristics.' We
(I)' further acknowledge that information provided by, and through,
the Agency may be incorrect because any medical and social history
and other information obtained by the Agency has ,been provided by
birthparents and/or by various other sources;
14. understand that there may be occasion when all medical bills are not
kno~m or presented to us (me) at the time of placement. Eecause of
unforseen circumstances, including insurance reimbursement requirements,
any medical bills presented to us (me), even after the placement and
adoption are completed, will remain our responsibility;
15.
agree to give Adoption Services the right to remove and/or
removal of the child from our family and terminate
relationship with us '(Ine) should, prior to finalization of
such action be deemed necessary by Adoption Services;
16. agree to provide Adoption Services with pictures of, and update's on, the
child we (I) adopt. These pictures (at least six each time) will be
provided at a minimum of three-month intervals for the first year after
placement and at a minimum of twice per year (in December and May) for
the next four (4) year5. Additionally, unless this sentence has been
crossed out and inl.tialed, we (I) agree to provide a "school picture"
l1t;ld update in December of each year, covering ages 5 through 18.. Each
tune pictures are sent, we (I) a'1ree to provide to Adoption Servl.ces a
written update regarding the chl.ld and his/her development. We (I)
understand that these pictures and written updates may be transmitted to
the birthparent (&) . We (I) understand and agree that this Contract,
including this section, shall Burvive the final adoption of a child by
us (me) and shall not be terminated by an adoption decree;
recon-mend the
the child's
the adoption,
Page 3 of 6
~';"lIlCrp;. ;;',-"':.;;'S,;~-:"""
. - , .' " . . ~' '.' '. '- ..--,', . , ; '. .'.' -,. ~ .', ','. " . '"," ,,:,. .' ".
12/01/98 15:03
~717 731 9157
ADO!'TIOS S\'CS
...... SACKS
~OOS
-:-.....
,.
17.
understand that by accepting physical custody of a child placed with us
(me), we (I) agree to, and shall, provide all necessary care of the
child until the placement is terminated or concludes in adoption.
should the placement be terminated for any reason, we (I.) release
Adoption Services from any and all liability therefrom;
understand that confidentiality is important to birthparents ,al1d to
adoptive families. While Adoption Services will take precautj,ons to
protect our (my) identity and that of the birthparents, by our (my)
design, the birthparent's design or by some possible error on the part
of Adoption Services, the, hospital' or attorneys involved, our (my)
identity and that of the birthparents could be divulged. If such
happens, ",e (I) release Adoption Services from any and all liability
therefrom. Additionally, we (I) understand that, in some instances,
adoptive parents who prefer anonymity may be confronted with
birthparents who, subsequent to placement, but prior to termination or
relinquishment, request a meeting with, or other identifying information
of, the adopting family. In such situations, we (I) agree to either
cooperate with the birthparents' request or, if so requested by the
birthparents~.,ye (I) will return the child to Adoption service~;
understand and agree that should we (I) violate any of the above
'.Contract, we (I) agree to pay any and, all legal :fees incurred by
Adoption Services to enforce the above and we (I) agree to pay Adoption
Services' current hourly rate for any and all time expended by Adoption
. Services' staff regarding this violation;
understand that we (I) must comply with all of the above secti~ns. as a
condition of the agency's Consent to the adoption;
2l. understand and agree that this Contract shall survive the final ~doption
of a child by us (me) and shall not be terminated by any ac.option
decree.
18.
19.
20.
Additionally, if we (I) have requested the assistance of Adoption
Services in matching' us (me) with a Chinese-born infant/child available for
adoption, we (I) state that we (I):
22. acknowledge that the various Gover~~ental agencies in China to whom
we are referred are not employees of Adoption Services and,
therefore,' the Agency is not responsible in any fashion or manner
for their actions; "
23. acknowledge and understand that any fees charged in the Peoples'
Republic of China, such as the donations to the Orphanage, child's
visa, etc., are to be paid ,by us (me). Additionally, travel, food
and lodging are the Adoptive Parent's sole responsibility;
24. understand and agree that no portion of fees paid to Adoption
Services are for legal services and/or costs in,.obtaining a US.
birth certificate, registering the adoption in a state court and/or
obt!l.+ning United States Citizenship;
Page 4 of 6
;-'2~-= ,-=,~,
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"
'li'717 731 0157
.-...
--------
'. . .~'.\" ,~I~, - \."-,_;-r., - ::,' "":--'--<'''''-~~--;,:,~~;;-'''~-;-::r.:.~.--~t:~-~ ," '.',." , ,_ . 1,'
raJoos
JDOPTIO:-l S\'CS
... S.\CKS
......
, .
25. aCknowlcdge, undcrstllnd and agrce that Adoption Scrvices is not
rcsPonsible for any foreign fees, expenses, travel expenses and/or
cost of any kind or nature that We (I) incur in the event that an
adoption is not completed;
26. understand and agree that in the Cvent that after placement, but
before finalizatiol1, a condition develops or is made known to .us
(me) which causes Us (me) to cnd the placement, we (I) understand
that no portion of the fees we (I) have paid will be refunded and
that Adoption Services shall not be responsible to Us (me) for any
damages relating to the placement;
27. acknowledge that Adoption Services is not responsible for our (my)
safety and/or safety of the child at any time during the adoption
process;
28. understand that the results of any medical tests and exams for the
child will be given to us (me) but understand and .agree that the
Agency does not guarantee the accuracy of these reports. We (I l
accept such ~isks in accepting the placement of a child;
29. ,acknowledge and agree that Adoption Services cannot predict an
adoptivc child' s future including, but not limited to, emotional
and/or personality Characteristics, health, medical problems,
learning diSabilities, intellectual ability, hyperactivity,
attention deficits, appearance or inherited Characteristics. We
(I) further acknowledge that information provided by, and through,
the Agency may be incorrect because any medical and social history
and other information obtained by the Agency has been provided by
the birthparents and/or by various other sources;
30. understand that by accepting physical custody of a child placed
with us (me), we (I) agree to, and shall, provide all necessary
care of the child until the placement is terminated or concludes in
adoption. Should the placement be tcrminated for any reason, we
(I) release Adoption Services from any and all liability therefrom;
.
31.' understand and acknowledge that if a condition arises after the
finalization of the adoption, the child is ours (mine) and cannot
be returned to Adoption Services and/or Chinese authorities. We
(I) accept such risk and agree that Adoption Services shall not be
responsible to us (mc) or to our (my) child for any damages
relating to any condition;
32. understand and accept all the risks involved and we (I) will accept
our (rny) adoptiVe child and hold the Agency, its Directors,
faCilitators, officers and cmployees harmless and release said
Agency from any claims or liability;
33. agree that in the event that we (I) file any claim or action
against Adoption Services, without regard to the results, we (I)
agree to pay Adoption Services all cost it incurs in defending our
(my) claim.
Page 5 of 6
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12101/98
15:05
'5'717 73.\ 015'/
ADOPT/O:; SI'CS
......1
S.\CKS
1ilJ007
We (I), the undersigned, have read the above Contract and/or it has been
read to us (me) and we (I) understand and agree to all its provisions.
.. TJ (l '2i' l'
(-MU,"~;d b/"",/%,,_~
Prospective Adopting Parent
-2~/\ / /C~
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- '21
'~
DATE
Rev. 7/96
,;
.
Page 6 of 6
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'lr717 731 0157
ADO!'T10:; S\'CS
...... SACKS
.------
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t ~ ~~B~~,!~~P~" P~7~~~)~~~~~X ~7~~,~0157
PROSPECTIVE ADOPTING PARENTS CONTRACT
~.
We (I),
parents and request
state that we (I):
.the undersigned, are interested in
the assistance of Adoption Services.
becoming adoptive
Accordingly, we (I)
1. have read and understand the Adoption Services Program Description (Rev.
5/96) and Fee and Service Schedule (Rev. 7/96); ,
2. state that, with the exception of the information as specifically stated
in the Program Description and Fee and Service Schedule, no promises
and/or guarantees of any kind have been made or implied to us (me) by
Adoption Services or its staff;
3. understand that we (I) will be notified of any changes in the current
Fee and Service Schedule that will apply to us (me) and agree to pay
Adoption Services for services rendered in accordance with the Fee and
Service Schedule that is in effect at the time the services are
rendered;
4.
understand that if we
Adoption Services, we
stated in the Adoption
(I) provide
(I) forfeit
Services Fee
false or misleading info=ation
our (my) right to any refunds
and Service Schedule;
to
as
5. consent that Adoption Services and Adoption Services staff be permitted
to obtain copies of, and examine all, our (my) psychological, medical,
legal and other records and to interview all professional and lay
persons who ~~ght provide information regarding these records or provide
information related to our (my) desire to adopt a child; we (I) will
sign a release of information authorization form, as requested;
6." understand that the information given to Adoption Services as part of
the Registration, .Application, Horne Study processes and post-placement
visitations, may be contained in written and/or verbal reports prepared
by Adoption Services and given to necessary attorneys, courts, other
agencies or government authorities as may be required. Furthermore, we
(I) understand that any and all information and records related to the
adoption process.may be a~~tted as courtroom evidence and th~t Adoption
Services may use any and all info~tion as part of its preparation for
courtroom testimony;
D:hibit "6"
Page 1 of 6
12/01/98 15:06
'B'717 731 0157
...... S.\CKS
G1J009
ADOPTION S\'CS
7. understand that we (I) mayor may not agree with part of, or all of, any
reports, statements, concluoions nnd recortuncndations made by Adoption
Services regarding our (my) desire and/cir fitness to adopt a child;
however, we (I) hereby release Adoption Services' and/or its staff from
any and all liability arising from information contained in thcir
reports and/or conclusions and/or recommendations;
- 8. understand that a Home Study and/or Pre-placement Report compret::ed by
Adoption Services does not in any way guarantee that a child referral
will be made by Adoption Services or that the Adoption Services' Rome
Study or Pre-Placement Report will be.accepted by other private agencies
and/or local courts; and
9. agree to keep .Adoption Services informed of any material changes or
anticipated changes in our (my) health or family including separation,
,marital changes, pregnancy, change of residence, change of employer and
change in family structure;
.Additionally, if
Services in matching
adoption, we (I) state
we (I) have
us (me) with
that we (I):
requested the assistance of Adoption
a US-born infant/child available for
10. ,. understand that in all domestic (US) adoptions at least three post-
placement visitations are required by Adoption Services and/or by state
law/regulations. should we (I) not comply with this rcquireme~t, we (I)
understand that the placement of the child may be in jeopardy; however,
in such instances, we (I) release Adoption Services from any ar:d all
liability therefrom.
ll. u~1derstand that in. cases inVOlVing the placement of a chil,d, such
placement will likely take place prior to the termination or
relinquishment of the biological parents' rights. In such instances, we
(I) recognize that, prior to the termination or relinauish:nent of'
parental rights, either biological parent may change - their mind
regarding the adoption process and may reouest the return of the child.
We (I) also recognize that the request for return, and return, of the
child could result in emotional turmoil and financial loss to us (me),
including the loss of Adoption Services' travel fees, the birthparents'
and agency's attorneys fees and birthmother and baby hospital/medical
related costs. In such an instan<:e, we (I l release Adoption Services
from any and all liability therefrom. Furthermore, in such an instance,
we (I) agree to deliver the child to the ~.doption Services' office on
the date and ti.me requested by Adoption Services. In the event that we
(I) fail to comply with the demand to return the child, \ole (I) authorize
the agency to disclose our (my) identity to the natural parents and to
any and all other persons as deemed necessary by the agency to permit
the birthparents to pursue,the rcturn of their child. Additionally, ~e
(I) agree to pay for any and all time and legal fees incurred by
Adoption Services to enforce the above;
.
Page 2 of 6
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'B7]7 731 0157.
ADOM"IO;'.;, 51'C5
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12. understand that Adoption Services asks that each birthmother and, when
posoiblc, each birthfather complete a Birthparent Health and Genetic
History Information Form. The birthmother is abo asked to sign a
relcase form allowing medical information and hospital records to be
relcased to Adoption Services and/or its attorney. We (I) understand
that we (I) \4ill be given copies of the Birthparent Health and Genetic
History Info~~ation Form with the identifying information removed. We
(I) understand, and fully acknowledge, that the medical information
given to Adoption Services and passed onto us (me) may be incomplete or,
at times, misrepresented by the birthparents. We (I) understand that
Adoption Services does not make an independent investigation into the
birthpal:ents' background other than to detennine their intentions and
family history through interviews and conversations. Therefore, we (I)
understand Adoption Services cannot represent any and all of the risks
for the child' 5 health which may materialize in the present and/or
future. Accord~gly, We (I) hereby release Adoption Services and/or its
staff from any and all liabilit.y arising from information, lack of
infocmation or misinformation contained in information given to us (me)
about the backgrounds and medical conditions of the birthoother,
birthfather,.~heir families and the child;
13. .acknowledge and agree that Adoption Services cannot predict an
adoptive child' s :future including I but not limited to, emotional
and/or personality characteristics, health, medical probl~s,
learning disabilities,' intellectual ability, hyperactivity,
attention deficits, appearance or inherited characteristics. We
(II' further acknowledge that information provided by, and through,
the Agency may be incorrect because any medical and social history
and other info.~ation obtained by the Agency has'been provided by
birthparents and/or by various other sources;
14. understand that there may be occasion when all medical' bills a=e not
known or presented to us (me) at the time of placement. Because of
unforseen circumstances, including insurance reimbursement require~ents,
any medical bills presented to us (me), even after the place::-,ent and
adoption are completed, will remain our responsibility;
,
15,'
agree to give Adoption Services the right to remove and/or
removal of the child from our famly and terminate
relationship with us (me) should, prior to finalization of
such action be deemed nccessa~~ by Adoption Services;
l.6. agree to provide Adoption Services with pictures of, and 'updates on, the
child ,we (I) adopt. These pictures (at least six each time) will be
provided at a nunLmum of three-month intervals for the first year after
placement and at a minimum of twice per year (in December and Hay) for
.the next four (4) years. Additionally, unless this sentence has been
crossed out and .ini.tialed, We (I) agree to provide a "school picture"
and update in December of each year, covering ages 5 through 18. Each
time pictures are sent, We (II agree to provide to ~dcption Services a
written update regarding the child and his/her,. development; We (I)
underllta:>d that these pictures and written updatcll lX1y be transmitted to
the birthpa.ent (5) . We (I I uncerotand and agree that this Contract,
including this section, shall sur.vive the final adoption of a child by
us (me) and ohall not be terminated by an adoption decree;
recocmend the
the child' s
the adoption,
Pagc :l of 6
12/01/96 15:06
...... S:\CKS_ __.
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'B717 731 0157
ADO!'T10:-; S\'CS
i
17. understand that by accepting physical custody of a child placed with us
(me), we (Il agree to, and shall, provide all necessary care of the
child until the placement is te~inatcd or concludes in adoption.
Should the placement be terminated for any reason, we (I) release
Adoption Services from any and all liability therefrom;
18. understand. that confidentiality is important to birthparents and to
adoptive families. While Adoption Services will take precaut10'ns to
protect our (my) identity and that of the birthparents, by our (my)
design, the birthparent's design or by some possible error on the part
of Adoption Services, the.. hospital,' or attorneys involved, our (my)
identity and that of the birthparents could be divulged. !f such
happens, we (I) release Adoption Services from any and all liability
therefrom. Additionally, We (I) understand that, in some instances,
adoptive parents who prefer anonymity may be confronted with
,birthparents who, subsequent to placement, but prior to tenllnation or
relinquishment, request a meeting with, ~~. other identifying information
of, the adopting family. In such s5,tuations, we (I) agree to either
cooperate with the birthparents' request or, if so requested by the
birthparents, ~~ (I) will return the child to Adoption Services;
~.
"
19. ,.understand and agree that should We (I) violate a"-y of the above
Contract, we. (I) agree to pay any and all legal fees il'.curred by
Adoption Services to enforce the above and we (I) agree to pay Adoption
Services' current hourly rate for any and all time expended by Adoption
Services' staff regarding this violation;
20. understand that we (I) must comply with all of the above sections as a
condition of the agency's Consent to the adoption;
21. understand and agree that this Contract shall sur.ive the final'~doption
of a child by Us (me) and shall not be terrninated by any adoption
decree.
Additionally, if we (I) have.requested the assistance of Adcption
Services in matchino' us (me) with a Chinese-born infant/child available for
' ~
adoption, we (I) state that we (I):
22.
'.
acknowledge that the various Governmental agencies in China to whom
we are referred are not employees of Adoption Services and,
therefore, the Agency is not responsible in any fashion or manner
for their actions; '.
23. acknowledge and understand that any fees charged in the Peoples'
Republic of China, such as the donations to the Orphanage, child's
visa, etc., are to be paid,by us (me). Additionally, travel, food
and lodging are thc Adoptive Parent's sole responsibility;
24. unde:::stand and agree that no portion of fees paid to Adoption
Serv~ces are for lcgal services and/or costG in obtaining a US.
birth certificate, registering the adoption in a state court and/or
obta~ning United States Citizenship; .,
Pag!! 4 of 6
._'_'......,..~_., _c
12101/98 15:09
'B'717 731 0157
IaJ 012
^DOPTIO~ S\'CS
..of.. SACKS
~
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25. acknowlcdge. understand and agree that Adoption Services is not
responsible for any foreign fecs, expenses, travel expenses end/or.
cost of any kind or naturc'that we (I) incur in the event that an
adoption is not completed;
26. understand and agree that in the event that after placement, but
before finalization, a condition develops or is made known to ~us
(me) which causes us (me) to end the placement, we (I) understand
that no portion of the fees we (I) have paid will be refunded and
that Adoption Services shall not be responsible to us (me) for any
damages relating to the placement;
27. acknowledge that Adoption Services is not responsible for our (my)
safety andlor safety of the child at any time during the adoption
process;
28. understand that the results of any medical tests and exams for the
child will be given to us (me) but understand and agree that the
Agency does not guarantee the accuracy of these reports. We (I)
accept such risks in accepting the placell'.ent of a child;
29. 'acknowledge and agree that Adoption Services cannot predict an
adoptive child' s future including, but not limited to, emotional
and/or personality characteristics, health, medical problems,
learning disabilities, intellectual ability, hyperactivity,
attention deficits, appearance or inherited characteristics. We
(I) further acknowledge that information provided by, and through,
the Agency may be incorrect because any medical and social history
and other information obtained by the Agency has been provided by
the birthparents and/or by various other sources;
30. understand that by accepting physical custody of a child placed
with us (me), we (I) agree to, and shall, provide all necessary
care of the child until the placement is terminated or concludes in
adoption. Should the placement be terminated for any reason, we
(I) release Adoption Services from any and all liability therefrom;
31. understand and acknowledge that if a condition arises after the
finalization of the adoption, the child is ours (mine) and cannot
be returned to Adoption Sel'Vices and/or Chinese authorities. We
(I) accept such risk and agree that Adoption Services shall not be
responsible to us (me) or to ot.:r (my) child for any damages
relating to any condition;
32. understand and accept all the risks involved and we (I) will accept
our (my) adoptive child and hold the Agency, its Directors,
fAcilitators, officers and employees harmless and release said
Agcncy from any claims or liability;
33. agree that in the cvent that we (I) file any claim or action
against Adoption Services, without regard to the results, we (I)
agree to pay Adoption Services all cost it incurs in dcfending our
(my) clafr.1.
Page 5 of 6
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12101/98 15:10
'/3717 731 0157
ADOPTIOS 5\'CS
...... SACKS
1i1J013
We (I), the undersigned, have read the above Contract and/or it has been
read to us (me) and we (I) understand and agree to all its provisions.
DATE
(Y"y-, "" \c... @'''''' L,,{/'F:tJ\,-
Prospective Adopting Parent
:2 -2')- C; 7.
DATE
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Prospective Adopting Parent
~6-.,~jq 1
Rev. 7/96
.
PagQ 6 of 6
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SMIGEL. ANDEHSON & SACKS
ATTORNEYS AT LAW
LE:ROY SMIGeL
c, LeI: ^NOCRSON
STU^RT S, S^CKS
-JOHN W. fROMME:R
-JOSCPH B. O'M"'lCO
ANN V, LCVIN
HEA THCR 0, ROYCR
CRIC M. MORRISON
2917 NORTH FRONT STm:cT
HARRISBURG, PENNSYLVANIA 17110-1223
17171234-2401
fAX 17171 0234.3611
'4blj'f~ 2-1
March 24, 1999
FOR PROFESSIONAL SERVICES:
Aug, - Sep, 1998 I Phone conferences with client; review and research 150,00
regarding enforcement of contracts; diversity of
jurisdiction,
Noy, 1998 1.2 Preparation of Complaint. 190,00
Dee, 1998 Research equity issues; correspondence regarding 135,00
filing and service,
Jan, 1999 ,8 Phone conferences regarding service issues 128,00
Feb, 1999 1.4 Preparation of correspondence regarding judgment; 224,00
phone conferences with Sheriff.
Mar, 1999 \.3 Phone conferences; preparation of Motion for Default 240,50
Judgment,
Filing, service costs 178,50
TOTAL $ 1,246,00
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ADOPTION SERVICES.INC.,
PLAINTIFF
IN TIlE COURT OF COMMON PLEAS
CUMBERLAND COUNTY. PENI"SYLVANIA
v,
No, 98- 7091
MAURICE G, BLANCHETTE and.
FRANKIE SUE BLANCHETTE.
husband and wi fc,
DEFENDANTS
CIVIL ACTION m EQUITY TERM
ORDER
AND NOW. _E~).t./
,::1000, upon considcration ofthc within Motion
to Amend Ordcr, it is hercby ORDERED and DECREED that this Court's Ordcr of June 10,
1999, be amended to require that (I) Dc(cmlants pay the Plainti IT the slim of Onc Thousand Two
Hundred Forty,Six and 00/100 Dollars ($ I ,246,(0) for attol11eys' fccs and costs inculTed in
bringing this action and (2) Defendants provide pictures of and updates about their adopted
children to the Plaintiffin accordancc with paragraph 17 of their Prospective Adopting Parcnts'
Contract dated August I I, 1997, to wit:
Defendants shall "providc Adoption Serviccs with picturcs of, and updates on, the
child wc (I) adopt. Thcsc picturcs (at least twclvc cach time) will bc provided at a
minimum of three-month intcrvals for the first ycar aftcr placcment and at a
minimum oft\\'icc per year (in Dcccmbcr and May) for thc ncxt four (4) years,
All picturcs are to be in focus with the child's featurcs clcarly visible, The
pictures will bc ofthc samc quality as thosc normally includcd in illY/Our family
picturc album, The updatcs arc to bc atlcast onc pagc in length (approximately
250-300 word minimum) and should be of a quality you would send to a close
relativc, Additionally, unlcss this se11lenee has bccn crosscd out and initialed, we
(I) agrce to providc a "school picture" and updatc in Deccmbcr of cach ycar,
covering ages 5 through 18, Each timc picturcs arc scnt, wc (I) agrce to providc
to Adoption Scrviccs a writtcn updatc regarding the child and his/hcr
devclopment. We (I) understand that these picturcs and writtcn updates may he
transmittcd to the bil1hparcnt(s), Wc (I) undcrstand and agH,'c' thatlhis Contract,
including this section, skill suni,.c the tinal adoption ofa child hy us (IllC) and
shai; not bc terminated by an adoption decrcc."
IIYT~
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Wll ERE FORE, Plainti CCprays that this Honorable Court amcnd its Ordcr oC Junc ! 0,
199'), to includc thc languagc oCparagraph 17 oCthc Prospcctive Adopting Parcnts' Contract and
Curt her ordering thc Prothonotary to cnter judgnll:nt on the Amcnded Order.
Date:
,A..'
, " )
,';. ,.0'",.'
----"-----
SMIGEL. ANDERSON 8: SACKS
C ,~~/,/~I
By: I if> (/.( 1 /
C. L e ndel:Son, Esquire ID 1121315
2917 ,orth Front Street
Harrisburg, PA 17110-1260
(717) 234.2401
Attorneys Cor Plainti CC
.i
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,
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"
ADOPTION SERVICI;S, INC"
PLAINTIFF
IN TilE COURT OF COi\HvION PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
v,
No,9S-7091
MAURICE G, BLANCHETTE and,
FRANKIE SUE BLANCHETTE,
husband and wife,
DEFENDANTS
CIVIL ACTION- EQUITY TERM
CERTIFICATE OF SERVICE
I, C. Lee Anderson, Esquire, hereby certify that a true and correct copy of the foregoing
Motion to Amend Order was served upon the following as addressed below by depositing the
~al11e in the Unitcd Slates Mail, first class, postage prepaid, at Harrisburg, Pennsylvania, on
-i, .'_ ". I,
'~ ,
,2000:
FRANKIE SUE BLANCHETTE
8105 BEAR HILL ROAD
ROYSE CITY, TX 75 I 89
MAURICE G, BLANCHETTE
R105 BEAR HILL ROAD
ROYSE CITY, TX 75189
Dale:_~' i ",
SMIGEL, ANDERSON 8:. /~ACKS
I,' / /.7
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~-,""'" .'.} j ",'
l3y:__~/ /,( .', k'_ (1 "(,, '"
C, Lee 'Andcrson, Esquire ID #2] 315
2917 1'<0I1h Fronl Street
HalTisburg, PA I7110-1260
(717) 23-i-2-iOl
Al10rneys for Plainliff
,
,I
II
I
I
I,
i:
, .... ,.....,...J::;,'"'Jo-::.l"~.I"~..,"'~,._:.'a.,:.:;.:_._,:',~"''''^.~;:::. w~';: t'~,....:"':""..-~~";.~r~...>,.-,~F-;~r;>"..-. "i~~'J,-_.'r:-_..'.'.'~-'--.. ",', '.'-, -:", ,~'/; ._, !
...'!I::'~ .~ ~.
WHEREFORE, Plainliffprays that this honorable court enter an order making the Rule
absolute, and
A, Requiring Defendants to provide pictures of and updates about their
adopted children to the Plaintiff in accordance with paragraph 17 of their Prospective
Adopting Parents' Contract.
B, Requiring Defendants to pay Plaintifflhe sum of One Thousand Two
Hundred Forty-six and 00/100 Dollars ($1,246,00) for attorneys' fees and costs incurred
to date in enforcing the parties' contract, or such higher amount as may eventually be
incurred as a result of enforcing said contract.
Respectfully submitted,
SMIGEL, ANDERSON & SACKS
Date: 11,1 ?l...1 ;.. 7, I c.r q ("r
{
derson, Esquire
1.0,#: 1315
2917 North Front Street
Harrisburg, P A 1711 0
(717) 234,2401
Attorneys for Plaintiff
<
CERTIFICATE OF SERVICE
I, C. Lee Anderson. Esquire, hereby certify that a true and correct copy of the forgoing
Motion to Make Rule Absolute was served upon the following as addressed below by depositing
the same in the United States Mail, first class, postage prepaid, on May 27,1999:
Frankie Sue Blanchette
8105 Bear Hill Road
Royse City, TX 75189
Maurice G, Blanchette
8105 Bear Hill Road
Royse City, TX 75189
/ ~.
~ / (;, /
1:...--', . ,,1/ ~--
C. Le ldersoll, Esquire
J.D, #: 21315
2917 North Front Street
Harrisburg, P A 17110
(717) 234-2401
Attorneys for Plaintiff
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482t.2.tll.:1.^!lkc!l'Jrdern-.larch 2-'.1999 ....1 PM
ADOPTION SERVICES. INC..
PLAINTIFF
IN THE COURT OF COMMONS PLEAS
CUMBERLAND COUNTY,
PENNSYL VANIA
J,
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V,
NO, 98,7091
MAURICE G, BLANCHETTE and
FRANKIE SUE BLANCHETTE.
Husband and wife.
CIVIL ACTION - EQUITY TERM
DEFENDANT
ORDER
AND NOW,
1999. upon consideration of the within Motion for
Default Judgment. it is hereby ORDERED and DECREED that 1) Defendants pay the Plaintiff
the sum of One Thousand Two Hundred Forty-six and 00/100 Dollars ($1,246,00) for attorneys'
fees and costs incurred in bringing this action, and 2) Defendants provide pictures of and updates
about their adopted children to the Plaintiff in accordance with Paragraph 17 of their Prospective
Adopting Parents Contract dated August 11,1997,
BY THE COURT,
7, Plaintifrs Complaint also requests that Defendants be ordered to provide pictures
of and updates about their adopted childrcn to the Plaintiff in accordance with Paragraph 17 of
their Prospective Adopting Parents Contract,
8, Pa, R, C, p, No, 1037(c) provides that "In all cascs, the court, on motion ofa
party, may enter an appropriate judgment against a party:upon default or admission,"
9, Plaintiff, to date, has incurred additional costs and attorneys' fees totaling One
Thousand Two Hundred Forty-six and 00/100 Dollars ($1,246,00), as evidenced by the attached
statement marked Exhibit "B",
WHEREFORE, Plaintiff prays that this honorable court enter an order:
A. Requiring Defendants to provide pictures of and updates about their adopted
children to the Plaintiff in accordance with Paragraph 17 of their Prospective Adopting Parents
Contract.
B. Requiring Defendants to pay Plaintiff the sum of totaling One Thousand Two
Hundred Forty,six and 00/100 Dollars (51,246,00) for attorneys' fees and costs incurred to date
in enforcing the parties' contract; or such higher amount as ITlay eventually be incurred as a
result of enforcing said contract.
C. Granting such other relief as the court deems appropriate,
Respectfully submitted,
Date: 11lcI,u-t, )., Lfy~q9
,
I --
C. L e derson, Esquire
I.D, #: 21315
2917 North Front Street
Harrisburg, P A 17110
(717) 234-2401
Attorneys for Plaintiff
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CERTIFICATE OF SERVICE
I, C. Lee Anderson, hereby certify that a true and correct copy of Plaintiffs Motion for
Default Judgment was served upon the following as addressed below by depositing the same in
the United States Mail, first class, postage prepaid, on March:A<.f', 1999:
Frankie Sue Blanchette
8105 Bear Hill Road
Royse City. TX 75189
Maurice G, Blanchette
8105 Bear Hill Road
Royse City, TX 75189
/-J., ,
VI If.'
c, L7" Anderson, Esquire
LD,/#: 21315
2917 North Front Street
Harrisburg, PAl 711 0
(717) 234-2401
Attorneys for Plaintiff
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4d21.2'1/Ccmpla1~t/S~S/9~P lJIOJ/~a ~ll~pm
,.'
IN THE COURT OF CONNON PLEAS
CUHBERLA1'lD COUNTY, PENNSYLVA.>HA
NO. qr- '709/ r;~-r~ ,,<? Cl
f~ g ~
~~f:~. ~ ~.p1
2:':': ~m
CIVIL ACTION - IN EQq.~~r,~ C' :36
_'1""~ :::.,.,
:-~~ ~:.~ ~ i"~ ~
02 \9 ~rn
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YOU HAVE BEEN SUED IN COURT. If you wish to defend crgaiflst The
claims set forth in the following pages, you must take action within
twenty (20) days after this Complaint and Notice are served, by
entering a written appearance personally or by attorney and filing in
writing with the Court your defenses or objections to the claims set.
forth against you. You are warned that if you fail to do so the case
may proceed without you and a judgment may be entered against you by
the Court without further notice for any money claimed in the
Complaint or for any other claim or relief '!:equested by the Plaintiff.
You may lose money or property or other rights important to you.
ADOPTION SERVICES, INC.,
Plaintiff
v.
MAURICE
FRANKIE
husband
G. B~,CHETTE and
SUE BLANCHETTE,
and wife,
Defendants
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. ' . ' 11 "" . . ' , "
N
I
c
E
o
T
YOU SHOULD TAKE THIS Fl>.!?ER TO YOUR LA'tlYER AT ONCE. IF YOU DO NOT
HAVE ,.. LM1YER OR Cl>,NNOT l>.FFORD ONE, GO TO OR TELEFEONE TEE O?FICE SET
FORTH BELOW TO FIND OUT W.~ERE YOU CA-~ GET LEG.~ HELP.
Cumberland County Bar Association
2 Liberty Avenue
Carlisle, FA 17013
(717) 249-3l66
NOT I C I A
Le ban demandado a usted en la corte. Si usted quiere defenderse
de estas demandas expuestas en las paginas siguientes, usted tiene
viente (20) dias de plazo al partir de la facha de la demanda y la
notificacion. Usted debe presentar una apariencia
escrita 0 en Persona 0 por abogado y archivar en 1a corte en forma
escrita sus defensas 0 sus objectiones alas demandas encontra de su
persona. Sea avisado que si usted no se defiende, la corte tomara
medidas y puede entrar una orden contra usted sin previa aviso 0
notificacion y por cualquier queja 0 alivio que es pedido en la
peticion de demanda. Usted puede perder dinero 0 sus propiedades 0
otros derechos importantes para usted.
..a21.2'1/Co/llplA1~t./SJ:s/g~p 1.2/03/98 3158pm
ADOPTION SERVICES, INC.,
Plaintiff
IN THE COURT OF cO~IMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
NO. If_ 70 9/ ~ Ip-
v,
~~URICE G. BLANCHETTE and
FRANKIE SUE BLANCHETTE,
husband and wife,
Defendants
CIVIL ACTION - IN EQUITY
CONPLAINT
A."lD NOW comes ADOPTION SERVICES, INC., by its attorneys S~IIGEL,
ANDERSON & SACKS, and avers the following:
COUNT I - SPECIFIC PERFORMANCE
1. plaintiff is Adoption Services, Inc., an adoption agency
licensed in the Commonwealth of Pennsylvania, with its principal
office at 28 Central Boulevard, Camp Hill, cumberland County,
Pennsylvania.
2. Defendants are Maurice G. Blanchette and Frankie Sue
Blanchette, husband and wife, whose current ado'!:ess is 8105 Bear Hill
Road, Royse City, Texas 75189.
3. Plaintiff provides adoption services, including intermediary
services to arrange adoptions between biological parents and adopting
parents.
4. The services of the Plaintiff were provided to Defendant
pursuant to a contract, which was executed by the Defendants at the
offices of the Plaintiff on August ll, 1997. A copy of the contract,
entitled Prospective Adopting Parents Contract, is attached hereto as
Exhibit "1".
I
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5. Pursuant to the Contract, the Plaintiff placed two children
for adoption with the Defendants on August 14, 1997. For purposes of
this Complaint, the children are referred to as Dylan and Daniel.
6. The two children were adopted by the Defendants before the
Cumberland County Court on November 10; 1997.
7. Paragraph 17 of the Contract requires, inter alia, the
Defendants to provide pictures and updates about the children to
Plaintiff for approximately eighteen years.
8. Defendants are aware that. the requirement 'fo'!: pictures and
updates is a contractual requirement and is also relied upon by the
biological mother.
9. Plaintiff has made numerous and repeated requests to the
Defendants to provide the pictures and updates, but they have refused
or failed to do so.
10. Paragraph 20 of the Contract obligates the Defenda~ts to
pay, inter alia,.any and all legal fees incurred by Adoption Se~vices.
Inc. to enforce the Contract.
WHEREFORE, Plaintiff prays this Honorable Court to enter an Order
requiring the Defendants to comply with Paragraph l7 of the Contract
to supply pictures and updates for the duration of the time specified
in the contract, and to pay reasonable counsel fees incurred by the
Plaintiff, together with costs.
COUNT II - IN' ASSUMPSIT
1l. Plaintiff hereby incorporates the averments of paragraphs 1
through 10 by reference. as if more fully set out hereafter.
- 2 -
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12. Pursuant to the Contract of August 11, 1997, the Defendants
have failed to pay Plaintiff, for services rendered, the sum of
$16,361.00, evidenced by the invoice dated November 25, 1998, attached
hereto as Exhibit "2" and incorporated herein by reference.
13. Despite numerous demands by;Plaintiff, Defendants have
failed or refused to pay for the services rendered as set fo'!:th in
Exhibit "2".
14. Plaintiff also placed two other children with Defendants for
which there are outstanding balances owed.
15. In 1996, Plaintiff placed a child with the Defendants, said
child known as Taylor, who was also adopted by the Defendants in 1997
before this Court.
16. There remains a balance due of $95.00 for the placement of
Taylor, as represented by the invoice attached hereto as Exh,ibit "3".
17. Despite numerous and repeated requests by the Plaintiff,
Defendants have failed or refused to pay the $95.00 due as represented
by the invoice attached hereto as Exhibit "3".
18. In 1997, the Plaintiff placed a child with the Defendants,
said child known as Dominic, who was also adopted before this
Honorable Court in 1997.
19. For the placement of Dominic, there remains a balance due of
$lOO.OO, as represented by the invoice attached hereto as Exhibit "4".
20. Despite numerous and repeated requests by the Plaintiff,
Defendants have failed or refUsed to pay the $lOO.OO due, as
represented by the invoice attached hereto as Exhibit "4".
- 3 -
VERIFICATION
I, vincent F. Berger, Ph.D.;' President of Adoption Services.
Inc., a licensed adoption agency in the Commonwealth of pennsylvania,
verify that the statements contained in the foregoing Complaint are
true and correct to the best of my knowledge, information and belief.
I understand that false statements therein are made subject to the
penalties of 18 Pa.C.S. s4904, relating to unsworn falsification to
authorities.
vinfi~~
~nOPTION SERVICES, INC.
28 Central Boulevard
Camp Hill, PA 17011
Presid::1t
Date:
December 12--, 1998
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PROSPECTIVE ADOPTING PARENTS CONTRACT
He (I),
arents and request
tate that we (I):
the undersigned, are interested in
the assistance of Adoption services.
becoming adoptive
Accordingly, we (I)
, .,
have read, and understand the current Adoption Services ~rogram
Description and Fee and Service Schedulej
state that,.with the exception of the information as specifically stated
, ;in', the Program Description and Fee and Service Schedule, no promises
and/or guarant,ees of any kind have been made or implied to us., (me) J::y
Adoption Services or its staff;
understand' that we (I) will be notified of any changes in the current
Fee and Service Schedule that will apply to us (me) ,and agree' ,to pay
Adoption Services for services rendered in accordance with the Fee' ,.and
service Schedule that is in effect at the time the services are
rendered; ,
"
understand that if we
Adoption Services, we
stated in the Adoption
(I) provide false or misleading information
(I) forfeit our (my) right to any refunds
Services Fee and Service Schedule;
to
as
l. consent that Adoption Services and Adoption Services staff be permitted
to obtain copies of, and examine all, our (r.lY) psychological, medical,
legal and other records and to interview all professional and lay
persons who might provide information regarding these records or provide
information related to our (my) desire to adopt a child; we (I) will
sign a release ,of info~ation authorization form, as requested;
J. understand that the information given to Adoption Services as part of
the Registration, Application, Home. Study processes and post-placement
visitations, ,may be contained in written and/or 'verbal reports prepared
by. Adoption Services ,and given to necessary attorneys, courts, other
agencies.or government authorities as may be required. Furthermore, we
:' '.(I) '1J.nderstand that ,any and all information ;and records relate<;l to, the
,:",,' a~opj::ion process may, be, ad..-ni.tted ;as courtroom ,e'{idence ,and ,that ',Adoption
Services may ,)J.se any and all,inforrnation as part of: its preparation, for
courtroom testimony; ., .'.. '., '.- ':,.i.
D<hibit "1"
Page 1 of 6
...
understand that we (I) 'mayor may not agree with part of, or all' of, any
reports, statements, conclusions and recommendations made by Adoption
Services regarding our (my) desire and/or fitness to adopt a ,child;
however, we (I) hereby release Adoption Services and/or its staff from
any and all liability arising from information contained in their
reports and/or conclusions and/or recommendations;
3. understand that a Home Study and/or Pre-placement Report completed by
Adoption Services does not in any way guarantee that a child r.eferral
will be made by Adoption Services or that the Adoption' Services' Home
Study or Pre-Placement Report will be accepted by other private agencies
, . and/ or local courts i and
3. agree to keep Adoption Services informed of any material changes or
anticipated changes in our (my) health or family including separation,
marital changes, pregnancy, change of residence, change of employer and
change in family structu~~; , .
Additionally, if '.we . (I) have requested the assistance of Adoption
3erVices' in-. matching ~us (me) "with a US-born infant/child. available. for
~doption, we (I) st~te that we (I):
"
understand that in all domestic. (US) adoptions at least three post-
placement visitations 'are required by Adoption Services and/or by state
law/regulations. : Should 'we' (I) not comply with this requirement, we :(1)
unders~and that the placement of 'the child may be in jeopardy; however,
in such instances, we (I) release Adoption Services from any and all
liability therefrom.
ll. understand that in cases involving the placement of a child, such
placement will likely take place prior to the' termination or
relinquishment of the biological parents' rights. In such instances, we
(I) recognize that, prior to the termination or relinquis~~ent of
parental rights, either biological parent may change their mind
regarding the adoption process and may request the return of the child.
He (I) also recognize that the request for return, and return, of the
child could 'result in emotional turmoil and financial loss to us (me),
including the loss of Adoption Services' travel fees, the birthpa'!:ents'
and' agency's attorneys fees and birthmother and baby hospital/med.i.cal
related costs. In such an instance, we (I) release Adoption Services
from any and all liability therefrom. Furthermore, in such an instance,
we (I) agree to 'deliver the child to the Adoption Services' office on
. "..the' date' and time requested by Adoption Servic,:.a. In the event that we
.. (I) fail :to comply' with ,the demand to return the child, we.~(I) . authorize
::, the ,'ag'encyto disclose our (my) identity . to' the natural parents .and to
~ ': an'y, 'ana ;all :'othe'r ;pers'on"s :as 'de'emed necessary by' the agency. to permit
': ~ ,::the'/birth'pa're'nts to 'pursue the return 'of their: child. 'Additionally,. we
,: (I) . agree :toipay1 for 'any 'and, all 'time and legal fees'incurred by'
Adoption Services to enforce the above; , ,
10.
Page 2 of 6
:
,!
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"
2. understand that Adoption Services asks that each birthmother and, when
possible, each birth father complete a Birthparent Health and. Genetic
History Information Form. Th,e birthmother is also asked to ,sign a
release form allowing medical information and hospital records to be
released to Adoption Services and/or its attorney. We' (I) understand
that we (I) will be given copies of the Birthparent Health and Genetic
History Information Form with the ,identifying information removed. He
(I) understand, and ,fully acknowledge, that the medical information
given to Adoption Services and passed onto us (me) may be incomplete or,
,at times, misrepresented by the birthparents. 1'Ie(I) .understand that
Adoption Services does not make an independent investigation into the
birthparents '.. background other than to determine their intentions and
family history through interviews and conversations. Therefore, we,(I)
understand Adoption Services cannot represent any and all of the risks
for the child's, health which may materialize in the present' and/or,
future. Accordingly"we (I) hereby release Adoption Services and/or its
staff from any and, all liability arising from information, lack of
informatiqn or misinformation contained in information given to us (me)
about the backgrounds and medical conditions ,of the birt~~other,
birthfather ,~..heir families and the child; .' '
, ,
l3. acknowledge and agree that. Adoption, Services cannot predict: an ;
,adoptive child's future including, but not, limited to, emotional',
and/or personality;~ characteristics, health, medical.. proble:i1s,:.,;
learning disabilities, . intellectual ability, hyperactivity,
attention ..deficits, ,appearance or inherited characteristics. ',_He '.'
(I) further.acY~owledge that'information provided by, and through,
the Agency may be incorrect because any medical and social history
and other information obtained by the Agency has bzen provided by
birthparents and/or by various other sources;
l4. understand that, at the time we take custody of a child, we must escrow
anticipated birthmother and child medical fees. These moneys will be
escrowed with the agency's attorney. We (I) understand and agree that
all medical bills be paid, prior to the time of the final adoption
hearing'. Accordingly,. we (I) hgree that any medical bills/charges
outstanding just before the final adoption hearing will be paid from our
escrow account.. We '(I),can,then, on our (my) own, continue to resolve
any insurance reimbursement, although we (I) understand that insurance
reimbursement may not take place;
, . .. ,
l5. understand.. that there may be occasion when all medical bills', are. not
known or, presented to us (me) ,at the time of placement .or even,at,.the
time, of finalization. : ,Because ~,of I unforeseen circumstances," 'including
insurance reimbursement requirements, any medical:bills ,presented ,to us
(me), even after the placement and adoption are completed, will remain
our responsibility ,and ,we I( I ) 'agree ,to 'pay. any such medical bills :within
30 days of receipt ~f"th~.bill(6);' ,',',,',:.; ..,':;:~.:, .';; .....
16.
agree to, give Adoption Services the right to reI~:Jve and/or
removal; :of': the, ':child' from" cur family and terminate
relationship with us (me) should, prior to finalization of
such action be deemed necessary by Adoption Services;
.recommend the
the ,; child's
the adoption,
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l7. agree to provide Adoption. Services with pictures of, and updates on, the
child we (I) . adopt. 'rhese pictures (at least twelve each time)'will;be
'provided at a'minimum of three-month':intervals for the firstye'a:r;.:after
placement and at a'minimum of'twic'e per year. (in 'December and 'HaY)'::for
the next ,four (4)' years. ' All pictures are to, be .in .focus "with ,,'the
chilp.' s features clearly visible. The pictures will be' of,' the' 'same
quality as those normally included in my/our family picture album.'~: .The
, updates are to be at least one page in length (approximately '250-300
word. minimum) and should 'be 'of a quality you would send to :'a 'close
relative. ' Additionally,' unless this sentence has been crossed 'out 'and
initialed, we' (I)" agree' to provide a/"school. picture" and ,update in
December 'of each 'year, covering ages '5 'through 18.., Each time ,pictures
~. : are 'sent; -:we '(I) ;agree to -'provide 'to Adoption Services a 'written update
: : , regarding ;'the child and, his /he'r ,development. ,We' (I) . ',understand, that
,:'these' pictures ,:land, wri~ten'-,updates : may , be transmitted ,',to'l~the
, birthparent(s)~' :'We~.:(I) ',understand 'and agree 'that., this', Contract,'
, : including .this "'section;'.'shall : survlve' the final adoption' of a 'child by
us (me) 'and shall not 'be terminated by ,an adoption decree;' :.
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18. understand that"by accepting physical :custody 'of a child placed with us
(me!), we (I) agree to, and shall, provide all necessary care of the
child until' the 'placement is '. :terminated ' or . concludes ,in ,'adoption.
Should ,the placement be' terminated":for any reason" ,we (I). ,release
Adoption'Services",from a'ny:and allliability'therefromi" " ' ,
"..:.... -. ..;" -' -......'. ,', ... .. '.
19. understand that. confidentiality, is imoortant ,to birthoarents.. and to
adoptive -fa.'lli.lies. 'Hhile Adoption. Services will take. precautions to
protect our (my) identity and that 'of' the birthparents, by our '(my)
design, ,the birthparent' s design 'or by some possible error on .the part
of Adoption Services, the hospital or attorneys involved, our (my)
identity and that of the birthparents could be divulged. If such
happens, we (I) release Adoption ,Services from any and all liability
therefrom.' Additionally,' we (I), understand that, in some instances,
adoptive parents who prefer anonymity may be confronted ,with
birthparents who, subsequent 'to placement, but prior to termination or
relinquishment, request a meeting with, or other identifying information
'" of, .,the, ~dopting family.: ,In ,such.situations, we, (I) agree to',either
.-: cooperate with the birthparents '. request or, if so' requested "by :",the
birthparents, 'we (I) will .return. the child to Adoption Services; ;..,,.
20. understand and agree that should we (I) violate any of the above
Contract;,; we ,':(I) .. agree: to pay; any, and :all legal, fees ..incurred by
, - A~op~ion Services :t,o ,en~orce' :the :above, and we (I) :agree t~ pay 'Adopt~on
...""' : ,ServJ..ces' ,"current 'hourly' rate "':,for 1 any ',and :call time" expended by Adop~I,on
:.:: -Services' '6J:aff ,.regarding ~this 'vicilation; ~_':': .; :::,~,~:. .'..J.....,,:,; "..;:::.-:!i<:~~.!'
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21.';:~tinde~6~ahd othat":we ,,( I)~musti:~'omply.-,with'lall.,o'f C'.the labove ;!3ectio~~i1~s a
. condl:tl.<;ln. of., t~eJ!lgen'7Y '.6 Consent ,~o:lthe',adoption; ,:",:,J:',':;: ";'~"~".:?'~r
. I ., , :;'.. '.....,j,~~..' ._,...: ~'.',~,:~': '..:;.:'~..~;..,\:....~ :.:.'.~, :.,.-., ,,',...'.., " . ,._.' " :..;.:._,~..,#...:,#',
22.!! understand -and :agree ',that~thio Jcc:iii'tx:act' :shall Burvive :the 'finaledoption
, ':' 'of' a child ~ by, us " (me) and ',':shall :not : be teoonated' by ':any '''adoption
.'. ~,decree..1. :"', ,...~'... -..' :: -:''' . ,. .~....',. 'f .,...,,1 I"... .. .'... . l-l'~'''''''- ':.J:'.l~'!"l
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":, ;;'dditional~y ,,i,f.:we' '6) l!a--:e, re;1uested ~he assistanc~ bf: l\il.op~ion
~I."Vices in.. :matchJ..ng ,us ,(me)' ,wJ..th a :Ch:l.nese-born, ,Holdova-born,
ddnesti:'ovie~born" or Russian-born infant/child' available f'or' adcipticin, we
I) stat'e that we' (I):' , , ' ,-, ;,:,_:,::;~:.., ..,
3 .
:4.
!5.
, ' . .
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ackriciwledge';that'the various ,Coordinators ,and .GoverrunentaY,:agencies'
in'the 'foreign" c'ounti:1' to"whom we are':ieferred are:not employe'es' :of
Adoption :p~i;yices,' cii:td( ,th~ref~~e',', ',:t,he' ,Ag~~6y' is ;ricit respori.s,i!?~~-;i,~
an:(,Jas.l~J..o~:,~r-"I,n,~~m~F; ~,oi=',thel:r ',!l-,c,tJ..,?n~;: ,.',', ';';:,.'
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acknowledge and understand that any fees charged in, and/or by, the
fot'e.;gl},; c9.!lF.1,try, ~ucl}".?os ,.th,e d,9natio~s: t9 .the Orph,!-nage, ", c~ild.'.s
vis;;,;!'lt~.:,:ar_e"to .,be.paid by,us, (me)., . Adcg~ional1y, ,trave~,;food
and,lodgi!1g .,are th~, A9-optive, Parent' s, sole );,esponsibility; '~: .: :'
. ....., -. .'... '" '. '-.
understand and agree that no r::>rtion 'of fees paid' to :",cioption
Service~ ;:p;e. fgr, l<?gal :i:s,,?rvices ,and/o,r:, c~sts ,', in' ,obtainiI.1g, a, us
birth certific.a~e, ~egisteri~g ,the ad9ption;in, a ,statE) ~ourt and~or
obj:,aining Un~ted State~..cit;i,z~r:~i:!iP.i -; ,..',':~....:.,<'. ':':'-"..'.,:':';":' :'~ :::' !.L
'. .. ~.'
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acknowledge, understand and agree that l',doption Services is not
responsible for any foreign fees, expenses, travel expenses and/or
cost of any~kind or"nature"that we (I) il}cur,.in the event that an
adoption ,is ,not ,comp:J.eted!::.,' : 7" < " . . '.:, ' '~ , ,
understand and agree that in the event that after placement, but
before finalization, a condition develops or is made known to us
(me) which causes us (me) to end the' placement, we (I) unde'!:stand
that no portion of the fees we (I) have paid will be refunded and
that Adoption Services shall not be responsible to us (me) for any
damages . relating to the placement;',: ,." u_ ':., - -'
28. acknowledge that Adoption Services is not resconsible for our ,(my)
safety and/or safety of the child at any time during the adoption
process;
26.
27.
29.
understand that the results.".~'f any nie'dical tests and ,exams for the
child will'''be'-given - tous--(me),f:but,u'nderstana~ahd ';agree_ that the
Agency does not guarantee the accuracy of these reports. We, (I)
accept such risks ina,ccepting the ,place:n~'r1t of a child; ',' .
acknowledge 'and .' agree ':;'th~t',; Ad~p't"ion "s~;Yices"can~ot :p~'e'dici/'~a'n
adoptive ,child ',s . future, including ;.: but ',not :.limited ,;to, ,:; emotional
and/o1: personality'. characteristics, health,. ,medical,' 'problems,
lear~ing ,:,~.d~s,a~iltt~~'!! ?:J;':-i~~~el,l~~tu~l,;;, ,abi~,~ty'/,::.: hy~~ra~~~vi_~Y,
attention ,;deh,cJ..ts I :, appearance ~ or I inherited 'characterJ..stics .'~',~.We
(I I 'further'. 'acknowledge that' in'formation provided by, and through, L'
the Agency may be incorrect because any medical and social history:
and other information obtained by the Agency ha9 been provided-by
the birthparents and/or by variou9 other Dourcesi
.. j:; " -': ' ~
30.
1. understand that by accepting physical custody of a child ,pl"ced
. with, us (me"),' we' (I).' agree to, and' shall, ;.pro'vide ,alF.,~ecessary,
care of the child :Until the placcment is terminated' or' conclude~ in:'
adoption: . should ,th~ placement be 'tcnninated 'for ailY. i'eason; we
(I) release Adoption Services from any and all liability therefrom;'
2. understand and acknowledge that i 1: a condition arises after the
finalization of the adoption, the child is ours (mine) and,cannot
be 'returned 'to" Adoption "Servicc.s' 'and/or "the ~ authorities, from' the'
foreign country 'f;-~m' which the 'child .\;;a:5' aClopted ~': ~V7e ':;( I )",' accept
such risk and ;",gree that Adoption Services 'shall':not"be .'responsible
,to us (me) or to our (my) child for 'any' damages relat'ing to'-any'.
condition;. , . ,
,; ~.; \\-:l -:.o\::.:;:~! :\: ...:-: ,...:::-,:. '-1 :,. '. h! .:.. _ ,:.;.:,.~ :~~_._., "..;':':::: ..,,;~:-.... _".
13. unders'ta:i1d and' accept 'all the'iisks 'iilvolvE)d 'and 'we (I) : will:' accept
our '~'(my) ,': aaop1;:ive child 'and hold - the rAgency, =,-its : Dire6j:ors~
facilitators, 'officers' 'and :. employees' -hai:riUess 'and release~"~said
Agency from any claims or liability;
,..:,.::....,..,.-1:..:. i.'; ,7.':E('~ :~.D.:.:= z':: ::~:.,:.:'_~:c ..... ~.:.:::. ~:.:.'~:.:':' ;..:~:'3 :;-;.":,:"".,",:,:
34. agree, that' in' ~the ': eve'rit 'that "we (I) , 'file :any' 'claim '"Or action
against Adoption' Services,:' without:~regard 'to :the, re'sl.llts,';'we (I)
agree to pay Adoption Services all:cost~it 'incurs in'defending our
(my) claim.
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\-Ie "( I) ,', the' undersigned, have 'read 'the"above~ContiC:ct 'C:'nd/o'!:' it has
been read to us (me) and we (I) understand and agree to all its provisions.
\fl1~ D~ "if3L ~
Prospective Adopting Parent '
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.,of... -. '. ...'. J. '". Pp;'.;:.:":.. ,::::j' ':';':::.ili:~:./:.:.l ":iOi'=. ~.z'''.:.h
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Rev. 6/9@(7 .~':':.~ ::.:::.. "l;~ !,"> .;,;'1 ",:.I~'.:.[;;i.,~ ,J/:lU o;:b~,.,o~x::H.; 7.~rlJ~.~ ',II!
papc.as . )) , 1:,.:.-:"" ',:"': :,~~'':~",:': ........ .';:~,' .'....: j-;'~'1.10~n.L tJ.~ ~..l.:1 .('.::,:.)..,\ !.o:I;'
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Pagc 6 of 6
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11/24/98 \3:08
'3'717 73\ 0157
ADOP'J'IO:; SVCS
"of" SACKS
IilI 004
" ,",' ~:. " ,'':"',:''''..",'' ,":'. ": ' /", , :', '
Adoplion Services, Inc.
28 Cenlral Blvd,
Camp HiU, PA 17011
fU.~ 1I~3
Statement
DATE
11125/98
TO:
Mo &. FrJJ1kie Sluebelto
810~ Beu Hill Ro,d
Royse Ci:y IX 75189
"
AMOUNT DUE AMOUNT ENC.
$16,361,00
DATE TRANSACTION Ml0UNT 8ALANCE .
\21311')5 Bal,o"" focw",j 0.00
081131'17 !NY '5604 975,00 975,00
08113/91 PM'!" #1879 .915,00 0,00
OSll5rn !NY N5610 1,350,00 1,350,00
08115/97 !NY NS611 405,00 1,755.00
08f27/97 INY '5632 \3,150,00 14,905,00
11101/97 INY NS758 1,200,00 16,105,00
lllOlli97 !NY '5760 200,00 \6,305,00
11/14/91 L'lV '5768 56,00 16,361.00
CURRENT 1.30 DAYS PAST 31.60 DAYS ('AST 61,90 DAYS' PAST OVER 90 DAYS MlOUNT DUE
DUE DUE DUE PAST DUE
0,00 0.00 0,00 000 \6,:161.00 SI6,)61.oo I
-
Exhibit "2"
11/24/98 13:07
'B717 731 0157
ADOPT 1 O~ SI'CS
...... S,\CKS
~002
Adoptio:! Services, Jne,
28 Central Blvd,
CnmpHill, PA 17011
0j.~ t1 /
Statement
DATE
11/25/98
TO:
Bfanchette. M.1urice &. Fr3llk.ic
8105 Bur Hill Road
Royse Ci'y TX 75 189
AMOUNT DUE AMOUNT ENC,
595,00
DATE TRANSACTION AMOUNT BALANCE
12/31t'JS Balance (orwud 0,00
05117196 !NY #4889 - 475,00 475,00
05/17/96 PMT #1303 -475,00 0,00
06112i'J6 !NY #49:33. 5,00 5,00
06/lJ/96 PMT#I17:1.7 -5.00 0,00
07110/96 !NY 14999 - 20.50 20.50
07/10/96 !NY 15002 - 3,275,00 3,295.50
07/11/96 PMT 11372 -3,295.50 0.00
C8/02i'J6 INV 1IS057 - 1,140,00 1,140.00
09/04/96 p~rr 11454 .I,HO,oo 0,00
10,1)'2,"'6 J.."N #5170- 1>0,00 190,00
11/0 1196 !NY #5215 . 1,615,00 1,805,00
01120197 PMT #1636 -1,822,00 -17,00
04/02"97 !NY #5410/11 13,017.50 13,000,50
04/02,1/7 I."N 1IS412 68.36 13,068,86
06.\)2i'J7 PMT #3291 -13,068,86 0,00
06/1JM7 INV '5483 95,00 95,00
CURRENT 1.20 UAY:> I"A:>I 31-60 UAY_:> PAST 61.90 DAYS 1"A::i uVEA 90 DAYS AMOUNT DUE
DUE DUE DUE PAST DUE
000 0,00 0.00 0.00 95.00 l?l,oo
Exhibit ")"
11/24/98 13:07
'lS717 731 OIH __
. H S.\CKS
~003
ADOI'TIO:-l SYCS
Adoption Services, Inc,
28 Cenlrall3lvd.
Camp Hill, PA 17011
Statement
~ !i-J.
DATE
1l/25/<J8
TO:
~LiUllo: &. Fralltie BI.ochette
810S ilc>rHilt Ro.d
Royse Ci<y TX 75189
AMOUNT DUE AMOUNT ENe,
5100,00
DATE TRANSACTION AMOUNT eALANCE
12f.lJJ35 B~..c:: forward 0,00
02f2A/97 !NY '5356 975,00 975,00
01J'24m PMT'1525 .975,00 0.00
OJfU/91 L'lV 15391 427.50 427.50
03/2f,,9'/ !NY '5392 1,235,00 1,~2.s0
03/U197 lNV .5393 190,00 1,852.50
03/26/97 !NY #5394 190,00 2,042.50
04,'08197 INVfI5422 6,295,00 8,337.50
07(J1/91 PMT 11876 ~,337.s0 0,00
07131/97 INV 155B5 1,140,00 1,140,00
oa,osm INV M5595 43,79 1,183.79
09/29/97 Pl--IT Nl94-S -1,183,79 0,00
10,02197 lNV '5698 100,00 100,00
CURRENT 1'30 D~Y::i PA::ir 31,60 UAY~:i t'A:ir 61'90DAY:iI"A~ UVEA 90 DAYS AMOUNT DUE
QUE DUE QUE PAST QUE
-
0,00 OCO 000 000 10000 $100,00
fJ<hibit It.;"
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12/01/98 15:01
'8717 7Jl OIS-L- _~OI"TIO~ SYCS
...... S,\CKS
filJ002
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PROSPECTIVE ADOPTING PARENTS CONTRACT
.. ,
,
We (1),
parents and request
state that we (1):
the undersigned, are ..interested in becoming adoptive
the assistance of Adoption Services. Accordingly, We (1)
1. have read and understand the Adoption Services Progra~ Description (Rev.
5/96) and Fee and Service Schedule (Rev. 7/96);
2. state that, with the exception of the information as specifically stated
in the Program Description and Fee and Service SChedUle, no promises
and/or guara~tees of any kind have been made or implied to us (me) by
Adoption Services or its staff;
3. understand that we (1) will be notified of any changes in the current
Fee and Service Schedule that Hill apply to us (me) and agree to pay
Adoption Services for services rendered in accordance with the Pee and
Service 'Schedule t.hat is in effect at the time the services are
rendered;
4. understand that if we (1) provide false or rni!!leading infor.r.ation to
Adoption Services, We (I) forfeit our (my) right to any refunds as
stated in th~ Adoption Services Fee and Service Schedule;
5. consent that ,Adoption Services and Adoption Services staff be permitted
to obtain copies of, and examine all, our (my) Psychological, medical,
legal and other records and to interview all professional and lay
persons who might provide information regarding these records or p'!:ovide
information related to our (my) desire to adopt a child; we (I) will
sign a release of information authorization form, as requested;
6. , understand that the information given to Adoption Services as part of '
the Registration, APPlication, Home Study processes and Post-placement
ViSitations, may be contained in written and/or verbal reports prepared
by Adoption Services and given to necessary attorneys, courts, other
agencies or government authorities as may be required. 'Furthermore, we
(r) understand that any and all information and records related to the
adoption process ~~y be admitted as courtroom evidence and that Adoption
Services may Use any and all information as part of its preparation f~r
Courtroom testimony;
Exhibit "5"
Page 1 of G
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ADOPTION SVCS
. H S,\CKS
~003
, ,
7. understand that We (II mayor may not agree with part of, or all of, any
reports, statement", conclusions and recommendations made by Adoption
Services regarding our (my) desire and/or fitness to adopt a, child;
however, we (I) hereby release Adoption Services and/or its staff from
any and all liability arising from infOrmation contained in their
reports and/or conclusions and/or recommendations;
8. understand that a Home Study and/or Pre-placement Report compl'eted by
Adoption Services does not in any way guarantee that a child referral
will be made by Adoption Services 01;. that the Adoption Services' Home
Study or Pre-Placement Report will be accepted by other private agencies
and/or local courts; and
9. agree to keep Adoption Services informed of any material changes or
anticipated ..changes in our (my) health or family inclUding separation,
marital changes, pregnancy, change of residence, change of employer and
change in family structure;
Additionally, if we (I) have
Services in matching us (me) with
adoption, we (I) state that we (I):
10. ,.understand that in all domestic (US) adoptions at least three post-
placement visitations are required by Adoption Services and/or by state
la...../regulations. Should \~e (II not comply with this reqUirement, we (I)
understand that the placement of the child may be in jeopardy; however,
in such instances, we (II release Adoption Services from any and all
liability therefrom.
requested the assistance of Adoption
a US-born infant/child available for
11. understand that in ,cases inVOlVing the placement of a child, such
placement will likely take place prior to the termination or
relinquis~~ent of the biological parents' rights. In such instances, we
(I) recognize that, prior to the te~ination or relinquis~~ent of
parental rights, either biological parent may change their mind
regarding the adoption process and may request the return of the child.
We (I) also recognize that the request for return, and return, of the
child could result in emotional turmoil and financial loss to us (me),
inclUding the loss of Adoption Services' travel fees, the birthparents'
and agency's attorneys fees and birthmother and baby hospital/medical
related costs. In such an instance, we (I) release Adoption Services
from any and all liability therefrom. Furthermore, in such an instance,
We (I) agree to deliver the child to the Adoption Services' office on
the date and time requested by Adoption Services. In the eVent that we
(I) fail to comply with the demand to return the child, We (I) authorize
the agency to disclose our (my) identity to the natural parents and to
any and all other persons as deemed necessary by the agency to' penn.i.t
the birthparents to purSUe ~he return of their child. Additionally, we
(I) agret;! to pay fot, any and all time and legal fees incurred by
Adoption Services to enforce the above;
.
Pag<:! 2 of 6
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12101/03
'B'717 7Jl 0157
1 S: 0 2
ADOPTro:-; S\'CS
.. of of S,\CKS
~oo~
12. understand that Adoption Services asks that each birthmother and, when
posaible, each birthfnther complete a Birthparent llealth nnd Genetic
niatory Information Form. The birtlunother is also 'asked to sign a
release form allowing medical information and hospital records to be
released to Adoption Services and/or its attorney. We (I) understand
that we (I) will be given copies of the Birthparent Health and Genetic
History Information Form with the identifying information remov1!d.. We
(I) understand, nnd fully acknowledge, that the medical information
given to Adoption Services and passed ,'onto us (me) may be incomplete or,
at times, misrepresented by the birlhparents. We (I) understand that
Adoption Services does nol: make an independent investigation into the
birthparents' background other than to determine their intentions and
family history through interviews and conversations. Therefore, we (I)
understand Adoption Services cannot represent any and all of the risks
for the child's health which may materialize in the present and/or
future. Accordingly, we (I) hereby release Adoption Services and/or its
staff from any and all liability arising from information, lack of
information or misinformation contained in information given to us (me)
about the backgrounds and medical conditions of the birthmother,
birthfather,:their families and the child; ,
13. 'acknowledge and agree that Adoption Services cannot predict an
adoptive child's future inclUding, but not limited to, emotional
and/or personality Characteristics, health, medical problems,
learning disabilities, intellectual ability, hyperactivity,
attention deficits, appearance or inherited characteristics.' We
(I)' further acknowledge that information provided by, and through,
the Agency may be incorrect because any medical and social history
and other information obtained by the Agency has .been provided by
birthparents and/or by various other sources;
l4. understand that there may be occasion when all medical bills are not
known or presented to us (me) at the time of placement. Eecause of
unforseen circumstances, including insurance reimbursement re~uirements,
any medical bills presented to us (me), even after the placement and
adoption are con~leted, will remain our responsibility;
15.
agree to give Adoption Services the right to remove and/or
removal of the child from our family and termi.nate
relationship with us '(me) should, prior to finalization of
such action be deemed necessary by Adoption Services;
16. agree to provide Adoption Services with pictures of, and update's on, the
child we (I) adopt. The3e pictures (at least six each time) will be
provided at a minimum of three-month intervals for the first year after
placement and at a minimum of twice per year (in December and Hay) for
the next four (4) years. Jl.dditionally, unless this sentence has been
crossed out and initialed, We (! I agree to provide a "Bchool picture"
and update in December of each year, covering ages 5 through 18. Each
time pictures are sent, We (II agree to provide to Adoption Service3 a
written update regarding the child and his/her development. We (1)
underBtand that these pictures and written updates may be transmitted to
the birthparent (&) . We (I) understand and agree that thiG Contract,
including thic section, Bhall Burvive the final adoption of a child by
us (me) and shall not be terminated by an adoption decree;
recoaunend the
the child I s
the adoption,
Page 3 of (j
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731 0157
ADOPTION S\'CS
~oos
SACKS
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17. nddorot"d th,t by d.."ti., ,hY'i." cn,tody ot , child ,l,cod with n,
(me), We (I) agree to, and shall, provide all necessary care of the
child until the placement is terminated O,t' concludes in adoption.
,"oold tho ,l,c'm,.t bo t'crn.l.'t'd to, 'dy r,..o., wo (I) role,,,
Adoption Services from any and all liability therefrom;
understand that confidentiality is important to birthparents ,and to
adoptive families. While Adoption Services will take precaut':i.ons to
,rotect dOr Cmy) id,.tity o.d th.t ot the birth,or'dt., by 0= Cmy)
d.olgd, the birth,or,,,,, d,.ig. " by ,_ ,ootibl, "ror Od the ,.rt
ot Adoptiod "~ic,., the. hoo,it". or 'ttoroey. involv'd, oor CmYI
identity 'dd thot ot the birth,",,,t. cOOld b, di~lg'd. If ,och
h.".oo, we (I) r",." Ado,tin. "roic" trom "y aod .11 ii.bility
therotr... Addi<1o",l1y, w, CII ..dor.t"d th,t, in .0.. i..t,nco"
'doptiv, ,oro.to who '''ter '''dymity noy b, cootr"t'd with
birth,.r'dt. who, .nb",n,.t to ,'.c,.,.t, bnt ,rior to t',,"n.tio. or
r"inqui''',nt, r',n,.t , ..'tin, with, or oth'r id,.titYin, interm.tio.
ot, the 'dO'''dg f=ily. I. 'och .it,.tiooo, w, CI) .gr.. to either
cooperate with the birthparents' reguest or, if so requested by the
birthparents'r.l:Ie (I) will return the child to Adoption Services;
18.
19.
Understand and agree that should We (I) violate any of the above
.Contr.ct, w. CI) ',r.. to "y "y "d'l1 iegal fe.. incnrred by
Ado,tio. "roie,. to o'forc, th, abov, "d w, CI) 'gr" to pay Adoptiod
"roic.., cnrr,.t honrly r.t, for "Y 'dd ," time 'xpend'd by Adoptiod
. Services' staff regarding this violation;
Understand that We (I) must comply with all of the abo~e section~ as a
condition of the agency's Consent to the adoption;
21. nod.,.t'dd .od .gree th,t thi, Cootr,.t 'h." 'n~ive the fin., 'doption
of · child by "' Cma) eod 'h'l1 "t b, t'crn.ld"'d by "y .doptiod
decree.
20.
Additionally, if We (I) have reguested the assistance of ./l.doption
'eroie" id metchiog.", Cmo) with . Chid'dO-bord idfedt/child available for
adoption, We (I) state that we (Il:
22.
acknowledge that the various Governmental agencies, in China to whom
'We are referred are not employees of Adoption Services and,
therefore, the Agency is not responsi.ble in any fashion or manner
for their actions; . .
23. aCkoowl'd,o ond ndd.cot'od th.t ady t", charg'd i. thc '''pI",
Republic of China, SUch as the donations to the Orphanage, child's
visa, etc., are to be paid ,by Us (me). Additionally, travel, food
and lodging are the Adoptive Parent.s sole responsibility;
" . nddor.t'dd'M 'g'e, th.t 00 ,oe"ao of fo" p.id to Adoption
So~ic" are foe "9" '''vice. ,"d/or CO,to in..obt.iding a Ug.
birth certificate, registering the adoption in a state court and/or
obtatning United States CitiZenship;
Page 4 of 6
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'a717 731 0157
-"OOPTIO:; SI'CS
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----
25. aCknowledge, understand and agree that Adoption Services is not
responsible for any foreign fees, expenses, travel expenses and/or
cost of any kind or nature that We (I) incur in the event that an
adoption is not completed;
26. understand and agree that in the event that after placement, but
before finalization, a condition develops or is made known to .us
(me) which causes us (me) to end the placement, We (I) understand
that no portion of the fees we (I) have paid will be refunded and
that Adoption Services shall not be responsible to us (me) for any
damages relating to the placement;
27. aclalo"ledge that Adoption Services is not responsible for our (my)
safety and/or safety of the child at any time during the adoption
process;
28. understand that the results of any medical tests and exams for the
child will be given to us (nle) but understand and agree that the
Agency does not guarantee the c:.ccuracy of these reports. We (r l
accept such ~isks in accepting the placement of a child;
29. ,acknowledge and agree that Adoption Services cannot predict an
adoptive child's future including, but not limited to, emotional
and/or personality Characteristics, health, medical problems,
learning diSabilities, intellectual ability, hyperactivity,
attention defiCits, appearance or inherited characteristics. We
(I) further acknowledge that information provided by, and t~ough,
the Agency may be incorrect because any medical and Social histcry
and othe~ information obtained hy the Agency has been provided by
the birthparents and/or by various other sources;
30. understand that by accepting physical custody of a child placed
with us (me), we (I) agree to, and shall, provide all necessary
care of the child Until the placement is terminated or concludes in
adoption. Should the placement be terminated for any reason, we
(I) release Adoption Services from any and all liability therefromi
,
31.' understand and acknowledge that if a condition arises after the
finalization of the adoption, the child is ours (mine) and cannot
be returned to Adoption Services and/or Chinese authorities. We
(I) accept such risk and agree that Adoption Services shall not be
responsible to us (me) or to our (my) child for any damages
relating to any condition;
32. understand and accept all the risks involved and we (I) will accept
our (my) adoptive child and hold the Agency, its Directors,
faCilitators, officers and employees hannll'ss and release said
Agency from any claims or liability;
33. agree that in the event that we (II file any claim or action
against Adoption Selvices, without regard to the results, we (I)
agree to pay Adoption Services all cost it incurs in defending our
(my) claim.
Page 5 of 6
12/01/98 15:05
'[S717 731 0157
...... SACKS
lal 007
^DOl'TIO~ SI'CS
We (I), the undersigned, have read the above Contract and/or it hus been
read to us (me) and we (I) understand and agree to all its provisions.
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DATE
Re,'. 7/96
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PROSPECTIVE ADOPTING PARENTS CONTRACT
~. .
We (I), 'the
parents and request the
state that we (I):
undersigned, are interested in becoming adoptive
assistance of Adoption Services. Accordingly, we (I)
1. .have read and understand the Adoption Services P~ogram Description (Rev.
5/96) and Fee and Service Schedule (Rev. 7/96);
2. state that, with the exception of the information as specifically stated
in the Program Description and Fee and Sel-vice Schedule, no promises
and/or guarantees of any kind have been made or implied to us (me) by
~doption Services or it.s staff;
3. understand that we (I) will be notified of any changes in the current
Fee and Service Schedule that will apply to us (me) and agree to pay
Adoption Services for services rendered in accordance with the Fee and
Service Schedule that is in . effect at the time the services are
rendered;
4. understand that if we (I) provide false or misleading info=ation to
Adoption Services, we (I) forfeit our (my) right 'to any refunds as
sta.ted in the Adoption Services Fee and Service Schedule;
5. consent that Adoption Services and Adoption Services staff be permitted
to obtain copies of, and examine all, our (my) psychological, medical,
legal and other records and to intervie~1 all professional and lay
persons who might provide information regarding these records or provide
information related to our (my) desire to adopt a childi we (I) will
sign a release of information authorization form, as requested;
6. '. understand that the information given to Adoption Services as part of
the Registration, Application, Horne Study pl'ocesses and post-placement
visitations, may be contained in written and/or verbal reports prepared
by Adoption Services and given to necessary attorneys, courts, other
agencies or government authorities as may be required. Furthermore, we
(I) understand that any and all information and records related to the
adoption process , may be admitted as courtroom evidence and that Adoption
Services may u~e any and all information as part of its preparation for
courtroom testimony;
Exhibit "6"
P"-ge 1 of 6
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12101/95
15:06
'[S717 731 0157
ADOPTION SI'CS
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7. understand that we (I) mayor may not agree with part of, or all of, any
reports, statements, conclusions and reconunendations made by Adoption
Services regarding our (my) desire and/or fitness to adopt a child;
however, we (I) hereby release Adoption Services' and/or its :;taff from
any and all liability arising from information contained in their
reports and/or conclusions and/or reconunendations;
, e. understand that a Home Study and/or Pre-placemp.nt Report compYeted by
Adoption Services does not in any way guarantee that a child referral
will be made by Adoption Services or that the Adoption Services' Rome
Study or Pre-Placement Rep~rt will be 'accepted by other private agencies
and/or local courts; and
9. agree to keep Adoption Services informed of any material changes or
anticipated changes in our (my) health or family including separation,
,marital changes, pregnancy, change of residence, change of employer and
change in family structure;
Additionally, if we (I) have requested the assistance of Adoption
Services in matchi!].g us (me) with a US-b<;lrn infant/child available for
adoption, we (I) scate that we (I):
10. ,'understand that in all domestic (US) adoptions at least three post-
placement visitations a'!:e required by Adoption .Services and/or by state
law/regulations. Should we (I) not comply with this requireme~t, we (II
understand that the placement of the child may be in jeopardy; however,
in such instances, we (I) release Adoption services from ar.y ar.d all
liability therefrom.
ll. understand that in, cases involving the placement of a ohil,d, such
placement will likely take place prior to the termina~ion or
relinquisr~ent of the biological parents' rights. In such instances, we
(I) recognize that, prior to the termination or relinquish.-nent of'
parental rights, either biological parent may change their mind
regarding the adoption process and may request the return of the child.
We (I) also recognize that the request for return, and return, of the
child could result in emotional turmoil and financial loss to us (me),
including the loss of Adoption Services' travel fees, the birthparents'
and agency' 5 attorneys fees and birthmother and baby hospital/medical
related costs. In such an instance, we (I) release l',doption Services
from any and all liability therefrom. Furthermore, in such an instance,
we (I) agree to deliver the child to the Adoption Services' office on
the date and time requested by Adoption Servi~es. In the event that we
(I) fail to comply with the demand to return the child, we (I) authorize
the agency to disclose our (my) identity to the natural parents and to
any and all other persons as deemed necessary by the agency to permit
the birthparent:; to pursue, the return of their child. Additionally, \:Ie
(I) agree to pay for any and all time and legal fees incurred by
Adoption Services to enforce the above;
.
Page 2 of 6
12/01/98 15:07
~717 731 0157
^DOI'TIO:'(, SI'CS
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12. understand that Adoption Services asks that each birthroother and, when
possible, e....ch birthfather complete a Birthp....rent Health and Genetic
History Information Form. The birthroother is also asked to sign a
release form allowing medical information and hospital records to be
released to Adoption Services and/or its attorney. We (II understand
that we (I) will be given copies of the Birthparent Health and Genetic
History Information Form with the identifying information removed. We
(I) underst....nd, and fully acknowledge, that the medical information
given to Adoption Services and passed onto us (me) may be incomplete or,
at times, misrepresented by the birthparents. We (I) understand that
JI.doption Services does not make an independent investigation into the
birthparents' background other than to determine their intentions and
family history through interviews and conversations. Therefore, we (I)
understand Adoption Services cannot represent any and all of the risks
for the child' s health which may materialize in the present and/or
future. Accord~gly, We (I) hereby release Adoption Services and/or its
staff from any and all liability arising from information, lack of
information or misinformation contained .in information given to us (me)
about the backgrounds and medical conditions of the birthcother,
birthfather,,~heir fanulies and the child;
13. acknowledge and agree that Adoption Services cannot predict an
adoptive child' s future including I but not limited to, emotional
and/or personality characteristics, health, medical probl~s,
learning disahilities, 'intellectual ability, hyperactivity,
attention deficits, appearance or inherited characteristics. We
(I)' further acknowledge that information provided by, and through,
the Agency may be incorrect because any medical and social history
and other information obtained by the Agency has' been provi.ded by
birthparents and/or by various other sources;
14. understand that there may be occasion whell all I:ledical' bills are not
known or presented to us (me) at the time of placement. Because of
unforseen circumstances, including insurance reimburs~~ent require~ents,
any medical bills presented to us (me), even after the place:r,ent and
adoption are completed, will remain our responsibility;
,
.
15.
agree to give Adoption Services the right to re~ove and/or
r~~oval of the child from our family and terminate
relationship w.l.th us (me) should, prior to finalization of
such action be deemed necessary by Adoption Services;
l6. agree to provide Adoption Services with pictures of, and'updates on, the
child ,we (I) adopt. These pictures (at least six each time) will be
provided at a minimum of three-month interval!; for the first year after
placement and at a lI'inimum of twice per year (in December and May) for
,the next four (4) years. Additionally, . unless this sentence has been
crossed out and initialed, we (I) agree to provide a "school picture"
and update in December of each year, covering ages 5 through 18. Each
timo pictures are sent, we (I) agree to provide to Adoption Services a
written update regarding the child and his/hor.. development.- He (I)
understand that these pictures and written updat\!B lM.y be transmitted to
the birthparent(s). We (I) understand and agree that thin Contract,
including thia section, nhall survive the final adoption of a child by
us (me) and shall not be terminated by an adoption decree;
recocmend the
the child's
the adoption,
Page 3 of 6
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20.
21.
12101/98 15:08
'B'717 731 0157
ADOPTION SYCS
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...... S,.s,CKS__.
tal 0 II
17.
understand that by accepting physical custody of a child placed with us
(me), we (Il agree to, and shall, provide all necessary care of the
child until the placement is terminated or concludes in adoption.
Should the placement be terminated' for any reason, we (I) release
Adoption Se~ices from any and all liability therefrom;
understand, that confidentiality is important to birthparents and to
adoptive families. While Adoption Services will take precautlons to
protect our (my) identity and that of the birthparents, by our (my)
design, the birthparent's design or by some possible error on the part
of Adoption Services, the.. hospital, ,. or attorneys involved, our (my)
identity and that of the birthparents could be divulged. If such
happens, We (I) release Adoption Services from any and all liability
therefrom.. Additionally, \ole (I) understand that, in some instances,
adoptive parents who prefer anonymity may be confronted with
,birthparents who, subsequent to placement, but prior to termination or
relinquishment, request a meeting with, or other identifying information
of, the adopting family. In such situations, we (I) agree to either
Cooperate with the birthparents' request or, if so requested by the
birthparents, ~e (I) will return the child to Adoption Services;
.'.
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18.
,understand and agree that should We (I) violate any of the above
Contract, we, (I) agree to pay any and all legal fees incurred by
Adoption Services to enforce the above and we (X) agree to pay Adoption
Services' current hourly rate for any and all time expended by Adoption
Services' staff regarding this violation;
unde'!:stand that we (I) must comply with all of the above sections as a
condition of the agency's Consent to the adoption;
understand and agree that this Contract shall survive the final'adoption
of a child by us (me) and shall not be terminated by any adoption
decree.
Additionally, if we (Il have requested the assistance of Adoption
Services in matching" us (me) with a Chinese-bo::n infant/child available for
adoption, we (I) state that we (Il:
22. acknowledge that the various Governmental agencies in China to whom
we are referred are not employees of Adoption Services ar-d,
therefore, the Agency is not responsible in any fashion or manner
for their actions; '.
23. acknowledge and understand that any fees charged in the Peoples'
Republic of China, such as the donations to the Orphanage, child's
visa, etc., are to be paid,by us (me). Additionally, travel, food
and lodging are the Adoptive Parent's sole responsibility;
24. understand and agree that no portion of fees paid to Adoption
Services are for legal services and/or costs in obtaining a US.
birth certificate, registering the adoption in a state court and/or
obta~ning United States Citizenship;, ..
Page 4 of 6
12/01/9S 15:09
en7 731 0157
^DOPTIO~ S\'CS
~..'.. SACKS
Iai 012
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25. acknowledge, understand and agree that Adoption Services is not
responsible for any foreign fees, expenses, travel expenses and/or
cost of any kind or nature'that we (I) incur in the event tha~ an
adoption is not completed;
26. understand and agree that in the event that after placement, but
before finalization, a condition develops or is made known to ~us
(me) which causes us (me) to end the placement, we (I) understand
that no portion of the fees we (I) have paid will be refunded and
that Adoption Services shall not be responsible to us (me) for any
damages relating to the placement;
27. acknowledge that Adoption Services is not responsible for our (my)
safety and/.or safety of the child at any time during the adoption
process;
28. understand that the results of any medical tests and exams for the
child will be given to us (me) but understand and agree that the
Agency does not guarantee the accuracy of these reports. We (I)
accept such risks in accepting the place~ent of a child;
29. 'acknowledge and agree that Adoption Services cannot predic~ e.n
adoptive child' s future including, but not limited to, emotional
and/or personality characteristics, health, medical problems,
learning disabilities, intellectual ability, hyperactivity,
attention deficits, appearance or inherited characteristics. We
(I) further acknowledge that information provided by, and through,
the Agency may be incorrect because any medical and social history
and other information obtained by the Agency has been provided by
the birthparents and/or by various other sources;
30. understand that by accepting physical custody of a child placed
with us (me I, we (I I agree to, and shall, provide all necessary
care of the child until the placement is terminated or concludes in
adoption. Should the placement be terminated for any reason, 'We
(I) release Adoption Services from any and all liability therefrom;
31. understand and acknowledge that if a condition arises after the
finalization of the adoption, the child is ours (mine) and cannot
be returned to Adoption Services and/or Chinese authorities. We
(I) accept such risk and agr~e that Adoption Services shall not be
responsible to us (me) or to our (my) child for any damages
relating to any condition;
32. understand and accept all the risks involved and we (I) 'Will accept
our (my) adoptive child and hold the Agency, its Directors,
facilitators, officers and employees harmless and release said
Agency from any claims or liability;
33. agree that in the event that we (I) file any claim or action
against i\doption Services, without regard to the result:!, we (I)
agree to pay Adoption Services all cost it incurs in defending our
(my) claim.
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Page 5 of 6
12/01/98 15:10
'B717 731 0157
ADOPTION sl'es
...... SACKS
G!1013
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We (I), the undersigned, have read the above Contract and/or it has been
read to us (me) and we (I) understand and agree to all its provisions.
-:\ ~ /)/1 17_
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Prospective Adopting Parent
7:6-.3}ct 1
DATE
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~rospective Adopting Parent
2-2")-97,
DATE
Rev. 7/96
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Page 6 of 6
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SMIGEL. ANDERSON & SACKS
ATTORNEYS AT LAW
r}.x 17171 234.3ell
LEROY SMIOeL
C, l.tE: ANDeRSON
STUART S. SACKS
.JOHN W, FROMMER
.JOStPH B. D'AMICO
ANN V. L.EVIN
HtATHtR D. ROYCR
ERIC M, MORRISON
2917 NORTH f'RONT STRCE:T
HARRISBURG, PENNSYLVANIA 17110-1223
17171234.2401
~'tif~2-1
March 24, 1999
FOR PROFESSIONAL SERVICES:
Aug, - Sep, 1998 1 Phone conferences with client; review and research 150,00
regarding enforcement of contracts; diversity of
jurisdiction,
Noy, 1998 1.2 Preparation of Complaint, 190,00
Dee, 1998 1 Research equity issues; correspondence regarding 135,00
filing and service,
JaIl, 1999 ,8 Phone conferences regarding service issues 128,00
Feb,1999 1.4 Preparation of correspondence regarding judgment; 224,00
phone conferences with Sheriff,
Mar, 1999 1.3 Phone conferences; preparation of Motion for Default 240,50
Judgment.
Filing, service costs 178,50
TOTAL S 1,246,00