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 9-B - Affidavit of financial disclosure - parents (private-placement)
S.S.L. § 374(6); Form 9-B
22 NYCRR 205.53(b)(8) (Affidavit of Financial
Disclosure - Parents -
Private-Placement)
9/99
FAMILY COURT OF THE STATE OF NEW YORK
COUNTY OF
________
In the Matter of the Adoption of
(he) (she) executed the same.
A Child whose First Name is
AFFIDAVIT OF
FINANCIAL
DISCLOSURE -
PARENTS
(Private Placement)
________
STATE OF NEW YORK )
ss:
COUNTY )
(and )
being duly sworn, depose(s) and say(s):
1. That deponent(s) reside(s) at and (is)(are)
the (petitioning adoptive parent(s) (birth or legal parent(s)) of the above-named adoptive child; and
2. That deponent(s) (has)(have) paid or given or caused to be paid or given or undertaken to pay or give the following expenses, contributions, compensation or things of value, either directly or indirectly, to any person, agency, association, corporation, institution, society or organization, in connection with the placing out of said adoptive child with deponent(s) or with the adoption of said child by deponent(s):
[Specify recipient, amount, form, and purpose of each payment. If none, so state.]
;
3. That deponent(s) (has)(have) requested, received or accepted, either directly or indirectly, the following compensation or things or value from any person, agency, association, corporation, institution, society or other organization in connection with the placing out of said adoptive child with deponent(s) or with the adoption of said child by deponent(s).
Form 9-B Page 2
[Specify source, amount, form and purpose of each payment requested or received. If none, so state.]
/
[FN ]
_________________________
*(Adoptive)(Birth)(Legal)Parent: typed or printed name/signature
/
_________________________
*(Adoptive)(Birth)(Legal)Parent: typed or printed name/signature
/
_________________________
*Attorney if any: typed or printed name/signature
_________________________
*Attorney's Address and Telephone number
Sworn to before me this day of , .
______________
Judge of the Court
[FN ] *Delete inapplicable provisions.
