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 25 - Order (conditional certification as a qualified adoptive parent)
D.R.L. §§ 115, 115-d Form 25
(Certification
as Qualified
Adoptive Parent)
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
PRESENT:
Hon.
Judge
________
In the Matter of the Adoption of
A Child Whose First Name is (Docket) (File) No.
ORDER
(Conditional Certification
as a Qualified Adoptive
Parent)
by
Adoptive Parent(s)
________
The petition of verified the day of ,
19, having been filed in this court on the day of, 19, applying for certification as (a) qualified parent(s) of the adoptive child above-named; and
The petition indicating no prior criminal convictions, pending child protective investigations, or founded findings of child abuse or neglect; and
A report having been filed herein by a disinterested person as defined in section 115-d of the Domestic Relations Law; and
Pending completion of any further reports, investigations or inquiries ordered by the Court or required by any other statute or Court rule;
Now, therefore, upon consideration of said report and all other relevant and material factors, it is hereby
Form 25 page 2
ORDERED that (is) (are)
conditionally certified as (a) qualified adoptive parent(s) of the above-named adoptive child and may accept physical custody of such child for the purposes of adoption prior to or contemporaneous with the filing of an adoption petition.
NOTICE: THIS ORDER OF CONDITIONAL CERTIFICATION IS VALID UNTIL REPLACED BY AN ORDER OF CERTIFICATION OR BY AN ORDER DENYING CERTIFICATION, BUT IN NO EVENT BEYOND 180 DAYS OF THIS DATE.
ENTER
______________
Surrogate
Dated:, 19.
