SUPERIOR COURT OF CALIFORNIA, COUNTY OF RIVERSIDE BLYTHE 265 N. Broadway, Blythe, CA 92225 HEMET 880 N. State St., Hemet, CA 92543 INDIO 47-671 Oasis St., Indio, CA 92201 INDIO 46-200 Oasis St., Indio, CA 92201 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar Number and Address) MURRIETA 30755-D Auld Rd., Ste. 1226, Murrieta CA 92563 RIVERSIDE 9991 County Farm Rd., Riverside, CA 92503 RIVERSIDE 4175 Main St., Riverside, CA 92501 RI-AD001 FOR COURT USE ONLY TELEPHONE NO.: E-MAIL ADDRESS (Optional): ATTORNEY FOR (Name): FAX NO. (Optional): PLAINTIFF/PETITIONER: DEFENDANT/RESPONDENT: CASE NUMBER: APPLICATION TO OBTAIN ADOPTION INFORMATION AND ORDER For the reason indicated below, permission is hereby sought: To obtain a certified copy of said decree of adoption. Other: Approximate date of adoption: Reason for request: I am I declare under penalty of perjury under the laws of the State of California that the information above is true and correct. Date: (TYPE OR PRINT NAME OF ATTORNEY PARTY MAKING DECLARATION) (SIGNATURE) ORDER Denied Set for Hearing: Good cause appearing therefore, permission is hereby granted the above named applicant to obtain the information and/or service herein above set forth. Dated: (JUDGE OF THE SUPERIOR COURT) Page 1 of 1 Adopted for Mandatory Use Riverside Superior Court RI-AD001 [Rev. 05/24/13] APPLICATION TO OBTAIN ADOPTION INFORMATION AND ORDER riverside.courts.ca.gov/localfrms/localfrms.shtml American LegalNet, Inc. www.FormsWorkFlow.com