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

Universal Citation: 22 NY Comp Codes Rules and Regs ยง 16-A
Current through Register Vol. 46, No. 12, March 20, 2024

Sec. 114 D.R.L. Form 16-A

(Application for Certified

Copy of Adoption Order-

After sealing of records)

12/97

SURROGATE'S 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 applicant(s)

(and)

reside(s) at (and)

(respectively) in the County of , State of

2. On or about the day of , 19 , 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 said 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 said order approving the adoption because of the following facts and circumstances:

.

WHEREFORE, applicant(s) pray(s) that the Court make an order directing the Clerk of the Court of the County of to prepare, certify 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.

Adoption Form 16-A page 2

______________

Applicant

______________

Applicant

______________

Petitioner

______________

Print or type name

______________

Signature of Attorney, if any

______________

Attorney's Name (Print or Type)

________

________

______________

Attorney's Address and Telephone Number

Adoption Form 16-A page 3

VERIFICATION

STATE OF NEW YORK )

)ss.:

COUNTY OF )

, being duly sworn, say(s) that (he) (she) (they) (is) (are) the applicant(s) 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 , 19 .

______________

(Deputy) Clerk of the Court

Notary Public

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