New York Codes, Rules and Regulations
Title 22 - JUDICIARY
Subtitle D - Forms
Chapter VII - Surrogate's Court Forms
Subchapter B - Adoption Forms Of The Surrogate's Court
Adoption Forms
Form 13-B - Order of adoption (private-placement)
D.R.L. §§ 111, 112(b), 113, 114 Form 13-B
(Order of Adoption
Private-Placement)
12/97
At a term of the Surrogate's Court of the
State of New York, held in and for the
County of ,
at New York
on , 19 .
PRESENT:
Hon.
Judge
________
In the Matter of the Adoption of (Docket)(File) No.
A Child Whose First Name Is
ORDER OF
ADOPTION
(Private-Placement)
________
The Petition of (and
), verified the day of , 19 , having been duly presented to this Court, together with an agreement on the part of the petitioning adoptive parent(s) to adopt and treat as (his) (her) (their) own lawful child and whose birth day is , 19 , and who was born at as set forth in the petition for adoption herein, said petition having been attached thereto and made a part thereof a document setting forth all available information comprising the adoptive child's medical history; together with the affidavit(s) of
and the consent(s) of
;
AND, although (his)(her)(their) consent(s) (is) (are) not required, the Court having given notice of the proposed adoption to
[recite facts relative thereto]
Form 13-B Page 2
AND the aforesaid petitioning adoptive parents and the adoptive child and all other persons whose consents are required as aforesaid having personally appeared before this Court for examination, except
;
AND an investigation having been ordered and made and the written report of such investigation having been filed with the Court, as required by the Domestic Relations Law;
(AND the Court having (shortened) (dispensed with) the six-month waiting period between its receiving the petition to adopt and this order of adoption, pursuant to section 116 of the Domestic Relations Law, because
;)
AND the adoptive child having resided with the petitioning adoptive parent(s) since (and the judge having dispensed with the six-month period of residency with the adoptive parent(s), pursuant to sections 112 and 116 of the Domestic Relations Law because
(iv) , CPLR 315 (Order of Publication412 of the Social Services Law, (AND there being available to this Court findings of a court inquiry made within the preceding twelve months, of the statewide central register of child abuse and maltreatment that the (child) (adoptive parent(s)) (is)(are) (not) a subject of or another person named in an indicated report filed with such register as such terms are defined in section 412 of the Social Services Law) and the Court having given due consideration to any information contained therein;
Form 13-B Page 3
AND this Court being satisfied that the best interests of the adoptive child will be promoted by the adoption and that there is no reasonable objection to the proposed change of the name of the adoptive child;
NOW, on motion of
Attorney for the petitioners) herein, and upon all the papers and proceedings herein, it is
ORDERED that the petition of (and
) for the adoption of
a person born on , 19 , at ,
be and the same hereby is allowed and approved; and it is further
ORDERED that the said adoptive child shall henceforth be regarded and treated in all respects as the lawful child of the said adoptive parent(s); and it is further
ORDERED that the name of the said adoptive child be and the same hereby is changed to and that
the said adoptive child shall hereafter be known by that name; and it is further
(ORDERED that the Clerk prepare, certify and deliver to
a copy of this order; and it is further)
ORDERED that the child's medical history, heritage of the parents, which shall include nationality, ethnic background and race; education, which shall be the number of years of school completed by the parents at the time of the birth of the adoptive child; general physical appearance of the parents at the time of the birth of the adoptive child, including height, weight, color of hair, eyes, skin; occupation of the parents at the time of birth of the adoptive child; health and medical history of the parents at the time of birth of the adoptive child, including all available information setting forth conditions or diseases believed to be hereditary, any drugs or medication taken during pregnancy by the mother; and other information which may be a factor influencing the child's present or future well-being, talents, hobbies and special interests of the parents as contained in the petition shall be furnished to the adoptive parents; and it is
Form 13-B Page 4
ORDERED that this order, together with all other papers pertaining to the adoption, shall be filed and kept as provided in the Domestic Relations Law and shall not be subject to access or inspections except as provided in said Law.
ENTER
______________
Surrogate
Dated: , 19 .
