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 26 - Petition for extension of expired certification
D.R.L. §§ 115, 115-d(9) Form 26
(Certification Petition
For Extension of Expired
Certification - Private
Placement)
12/97
SURROGATE'S COURT OF THE STATE OF NEW YORK
COUNTY OF
________
In the Matter of the Adoption of
A Child whose First Name is (Docket) (File) No.
PETITION
by Adoptive Parent(s) FOR EXTENSION
OF EXPIRED
CERTIFICATION
(Private Placement)
________
The Petitioner(s) respectfully allege(s) to this Court that:
1. (He)(She)(They) filed a petition to adopt the above-described child in this Court on , 19 .
2. Petitioner(s) (was)(were) certified as a qualified adoptive parent(s), by order of the Court, County of , dated , 19 , which order expired on , 19 , within one year prior to the filing of the adoption petition.
3. The following change(s) in circumstances relevant and material to such certification (has)(have) taken place since issuance and expiration of the last certification:
4. Submitted herewith is written verification of any such change in circumstances or lack thereof by , a disinterested person as defined in section 11-d(4) of the Domestic Relations Law.
WHEREFORE, petitioner(s) (pray) (prays) for an order extending the termination date of the earlier certification until eighteen months from the date of filing of the adoption petition, that is,
/
_________________________
Adoptive Parent: typed or printed name/signature
/
_________________________
Adoptive child if over 18: typed or printed name/signature
/
_________________________
Attorney if any: typed or printed name/signature
_________________________
Attorney's Address and Telephone number
Form 26 page 2
VERIFICATION
STATE OF NEW YORK )
)ss.:
COUNTY OF )
being duly sworn, says that (he)(she)(they) (is)(are) the Petitioner(s) in the above-named proceeding and that the foregoing petition is true to (his)(her)(their) own knowledge, except as to matters wherein stated to be alleged on information and belief and as to those matters (he)(she)(they) believes(s) it to be true.
/
_________________________
Adoptive Parent: typed or printed name/signature
/
_________________________
Adoptive Parent: typed or printed name/signature
Sworn to before me this day of , 19 .
______________
(Deputy) Clerk of the Court
Notary Public
Resworn to before me this day of , 19 .
______________
Judge of the Court
