27-D Waiver of notice of petition for access to sealed adoption records  

D.R.L. § 114

Adoption Form 27-D

(Adoption—Waiver of Notice of

Petition for Access to

Sealed Adoption Records)

(9/2006)

FAMILY COURT OF THE STATE OF NEW YORK

COUNTY OF

In the Matter of the Adoption of

(Docket) (File) No.

A Child Whose First Name is

WAIVER OF NOTICE OF PETITION

FOR ACCESS TO SEALED

ADOPTION RECORDS

1.

 

I am the [check applicable box]: □ Adoptive Mother □ Adoptive Father □ Other [specify]:

of the above-named child. I am 18 years of age or older.

2.

I am waiving the service of Notice of Petition for Access to Sealed Adoption Records in this matter and am consenting to the release of sealed adoption records to [specify]:

Dated:

____________

____________

(Signature of Interested Party)

STATE OF

______

)

COUNTY OF

_______

) SS:

On the

_______

day of

___

in the year

___

, before me, the undersigned,

personally appeared ______________, personally known to me or proved to me on the basis of satisfactory evidence to be the individual (s) whose name (s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their capacity (ies), and that by his/her/their signatures (s) on the instrument, the individual (s), or the person, upon behalf of which the individual (s) acted, executed the instrument.