16-A Application for certified copy of adoption order (after sealing of records)  

D.R.L. § 114

Form 16-A

(Application for Certified

Copy of Adoption Order-

After sealing of records)

(9/2006)

FAMILY COURT OF THE STATE OF NEW YORK

COUNTY OF

In the Matter of the Adoption of

 

(Docket) (File) No.

APPLICATION FOR

CERTIFIED COPY

OF ADOPTION

ORDER (After sealing

A Minor of the Age of

 

years

of records)

1. The applicants)

(and)

reside(s) at

(and)

 

(respectively) in the County of

, State of

2. On or about the

 

day of

 

, , an order was made by the Honorable

 

, a judge of the

 

Court of

 

County, State of New York, approving the adoption of the above- named child by

 

, and thereafter the order was duly filed in the office of the Clerk of the

 

Court of the County of

, and sealed.

3. It is necessary for the applicant(s) to obtain a certified copy of the order approving the adoption because of the following facts and circumstances [Explain.

Note: if the applicant is a Native-American individual 18 years of age or older who is seeking information and/or records regarding the birth parents' tribal affiliation, so indicate]:

.

WHEREFORE, applicant(s) request(s) that the Court make an order directing the Clerk of the

 

Court of the County of

to prepare, certify

STATE OF NEW YORK

 

)

 

)ss.:

COUNTY OF

 

)

, being duly sworn, say(s) that (he)(she)(they)(is)(are) the applicants) above named; that (he)(she)(they)(have)(has) read the foregoing application and the same is true to (his)(her)(their) knowledge except as to matters therein stated to be alleged on information and belief and as to those matters (he)(she)(they) believe(s) it to be true.

Subscribed and sworn to before me this

 

day of

, .