New York Adoption A Form Details

The New York adoption form is an important document for those seeking to adopt a child in the state of New York. The form must be completed and filed with the appropriate agency in order to initiate the adoption process. The purpose of this article is to provide an overview of the NY adoption form and its contents.

This knowledge will allow you to grasp better the details of the ny adoption form before you start filling it out.

QuestionAnswer
Form NameNy Adoption Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesny adoption form, ny 27 form, ny 27 a form, ny 27 sealed form

Form Preview Example

D.R.L. §114

Adoption Form 27-A

 

(Adoption--Petition for Access to

 

Sealed Adoption Records)

 

(9/2006)

SURROGATE’S COURT OF THE STATE OF NEW YORK

 

COUNTY OF ______________________________

 

...........................................................................................

 

In the Matter of the Adoption of

(Docket)(File) No.

A Child Whose First Name is

______________________

 

PETITION FOR

_____________________________________________

ACCESS TO SEALED

 

ADOPTION RECORDS

...........................................................................................

 

TO THE SURROGATE’S COURT OF THE COUNTY OF [specify]:_________________________

The Petitioner respectfully alleges to this Court that:

1.[Check applicable box]:

G I am the child who was adopted in the above-entitled proceeding.

G My relationship to the above-named child is as follows [specify]:______________________

__________________________________________________________________________________

2.a. I reside at [specify address and telephone number]:________________________________

___________________________________________________________________________________

b. My mailing address, if different from the above, is [specify]:_________________________

__________________________________________________________________________________

3.Upon information and belief, [check applicable box]:

G [Applicable where Petitioner is the adoptee]: I was born in [specify city, village or town and

State]:______________on or about [specify date]:__________________A certified copy of my birth

certificate is attached.

G [Applicable where Petitioner is not the adoptee]: [specify adoptee’s name]:______________

was born in [specify city, village or town and State]:____________on or about [specify date]: _______

A certified copy of the birth certificate is attached.

4.Upon information and belief, [check applicable box]:

G [Applicable where Petitioner is the adoptee]: I was adopted pursuant to court order in the

[specify county and court, if known]:_____________________________________________________

__________________________________________________________________________________

G [Applicable where Petitioner is not the adoptee]: [specify adoptee’s name]:______________

was adopted pursuant to court order in the [specify county and court, if known]:___________________

__________________________________________________________________________________

5.A request for information G has G has not been made of the Adoption Information Registry.

[Direct inquiries to: NYS Department of Health , Adoption Information Registry, P.O.

Box 2602, Albany, New York 12220- 2602, (518)474-9600]

6.The names, dates of death, permanent addresses of the adoptive parents, if living, and the

adoptee’s birth name, if known, are as follows [specify]: ______________________________

__________________________________________________________________________________

7.[Check applicable box(es)]:

G I am requesting access to sealed adoption records on medical grounds for the following

Adoption Form 27-A Page 2

reasons [specify]:____________________________________________________________________

__________________________________________________________________________________

[NO TE: If your request is based on medical grounds, you must attach a medical certification from a physician licensed to practice medicine in the State of New York addressing a serious physical or mental illness. Such certification shall identify the information required to address the illness.]

GI am requesting access to sealed adoption records for good cause, other than medical, for the following reasons [specify]:_________________________________________________________

__________________________________________________________.

G [Applicable to Native-American individuals 18 years of age and older]: I am requesting access to sealed adoption records, including information about my birth parents’ tribal affiliation(s), if any, and other information necessary to protect any rights flowing from such tribal affiliations.

8.No previous application has been made for the relief requested herein except as follows: [Enter

“NONE”, or specify]:___________________________________________________________

__________________________________________________________________________________

I understand that the Court may appoint a law guardian for the purpose of reviewing the file and determining whether the information being sought is in the file and to undertake such other and further instructions that the Court may require.

WHEREFORE, for the reasons stated above, I respectfully request access to the sealed adoption records and information sought above and for such other and further relief as this Court deems just and proper.

Dated:__________,____.

______________________________________

Petitioner’s signature

______________________________________

Petitioner: Print or type name

______________________________________

Attorney’ signature, if any

______________________________________

______________________________________

Attorney’s Address and Telephone number

 

VERIFICATION

STATE OF NEW YORK

)

 

:ss.:

COUNTY OF_______________)

being duly sworn, says that (he)(she) is the Petitioner(s) in the above-named proceeding and that the foregoing petition is true to (his)(her) own knowledge, except as to matters stated to be alleged on information and belief and as to those matters (he)(she) believe(s) them to be true.

______________________________________/________________________

Petitioner: typed or printed name/

Signature

Sworn to before me this_____

 

day of___________,_____.

 

__________________________

(Deputy)Clerk of the Court Notary Public

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