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.
| Question | Answer |
|---|---|
| Form Name | Ny Adoption Form |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | ny adoption form, ny 27 form, ny 27 a form, ny 27 sealed form |
D.R.L. §114 |
Adoption Form |
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Sealed Adoption Records) |
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(9/2006) |
SURROGATE’S COURT OF THE STATE OF NEW YORK |
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COUNTY OF ______________________________ |
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........................................................................................... |
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In the Matter of the Adoption of |
(Docket)(File) No. |
A Child Whose First Name is |
______________________ |
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PETITION FOR |
_____________________________________________ |
ACCESS TO SEALED |
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ADOPTION RECORDS |
........................................................................................... |
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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
G My relationship to the
__________________________________________________________________________________
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,
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
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
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
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VERIFICATION |
STATE OF NEW YORK |
) |
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:ss.: |
COUNTY OF_______________)
being duly sworn, says that (he)(she) is the Petitioner(s) in the
______________________________________/________________________
Petitioner: typed or printed name/ |
Signature |
Sworn to before me this_____ |
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day of___________,_____. |
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__________________________
(Deputy)Clerk of the Court Notary Public