New York Codes, Rules and Regulations
Title 22 - JUDICIARY
Subtitle D - Forms
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)
Subchapter B - Adoption Forms Of The Family Court
Adoption Forms
Form 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)
________
The undersigned applicant(s) respectfully show(s) that:
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
Adoption Form 16-A Page 2
and deliver to the applicant(s) a copy of the original order of adoption granted herein, and for such other and further relief as to the Court may be just and proper.
______________
Applicant
______________
Applicant
______________
Print or type name(s)
______________
Signature of Attorney, if any
______________
Attorney's Name (Print or Type)
________
________
______________
Attorney's Address and Telephone Number
VERIFICATION
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.
______________
Applicant
______________
Applicant
Subscribed and sworn to before me this day of , .
______________
(Deputy) Clerk of the Court
Notary Public
