14 Certificate of adoption, Adoption Forms, Subchapter B. Adoption Forms of the Family Court, Chapter IV. Forms of the Family Court of the State of New York and Adoption Forms of the Family Court of the State of New York (cf. s205.7), Subtitle D. Forms, TITLE 22. Judiciary, New York Codes Rules Regulations

D.R.L. § 114

Form 14

Adoption (Certificate of Adoption)

9/2005

FAMILY COURT OF THE STATE OF NEW YORK

COUNTY OF

CERTIFICATE OF ADOPTION

, Clerk of the

Court of

County, do hereby certify that I have inspected the records of this Court and find that:

AN ORDER OF ADOPTION was signed on the

day of

, , by Honorable

, Judge of the

Court of the County of

, granting the petition of

(and

), adoptive parent(s) of a child now known and called by the name of [specify]:

, who was born at

, on the

day of

, ;

This certificate as to the facts recited herein shall have the same force and effect as a certified copy of an order of adoption.

IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of the

Court of the County of

this

day of

, .

Clerk of the Court of the County of