Form DCF-738 "Agreement for Reimbursement of Non-recurring Adoption Expenses" - Connecticut

What Is Form DCF-738?

This is a legal form that was released by the Connecticut State Department of Children and Families - a government authority operating within Connecticut. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on November 1, 2007;
  • The latest edition provided by the Connecticut State Department of Children and Families;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form DCF-738 by clicking the link below or browse more documents and templates provided by the Connecticut State Department of Children and Families.

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Download Form DCF-738 "Agreement for Reimbursement of Non-recurring Adoption Expenses" - Connecticut

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Connecticut Department of Children and Families
AGREEMENT FOR REIMBURSEMENT OF NON-RECURRING ADOPTION EXPENSES
DCF-738
11/07 (Rev.)
Page 1 of 1
Adoptive Mother’s Name (LAST, First):
Adoptive Father’s Name (LAST, First):
Child’s Name (LAST, First):
Date of Birth:
Place of Birth:
I/We, affirm that I/We will be adopting the above named special needs child and agree to receive payments for
reimbursement of non-recurring adoption expenses incurred prior to the finalization of the adoption.
The Department will reimburse the following non-recurring adoption expenses:
Type of Expense
Estimated Cost
$ 0.00
TOTAL ESTIMATED COSTS
Adoptive Mother’s Signature:
Date:
Adoptive Father’s Signature:
Date:
Approved by Authorized Agent for the Department of Children and Families:
Date:
Date:
Signed copy of this agreement was
given or
sent to adoptive parents on:
Connecticut Department of Children and Families
AGREEMENT FOR REIMBURSEMENT OF NON-RECURRING ADOPTION EXPENSES
DCF-738
11/07 (Rev.)
Page 1 of 1
Adoptive Mother’s Name (LAST, First):
Adoptive Father’s Name (LAST, First):
Child’s Name (LAST, First):
Date of Birth:
Place of Birth:
I/We, affirm that I/We will be adopting the above named special needs child and agree to receive payments for
reimbursement of non-recurring adoption expenses incurred prior to the finalization of the adoption.
The Department will reimburse the following non-recurring adoption expenses:
Type of Expense
Estimated Cost
$ 0.00
TOTAL ESTIMATED COSTS
Adoptive Mother’s Signature:
Date:
Adoptive Father’s Signature:
Date:
Approved by Authorized Agent for the Department of Children and Families:
Date:
Date:
Signed copy of this agreement was
given or
sent to adoptive parents on: