(Court use only) Petition to Obtain Information From Superior Court Adoption File-Adoptee Family Code Section 9200 If this document is executed outside of the State of California, the affidavit of verification is to be executed before a notary public or other officer authorized to administer oaths. My name is:______________________________________________ Date of Birth: ________________ Superior Court of California, County of San Mateo Juvenile Division 222 Paul Scannell Drive San Mateo, CA 94402 www.sanmateocourt.org Address: _____________________________________________________ Case # Phone number: _____________________________ I am informed and believe that I was adopted by ____________________________________________ (complete first and last names) The adoption took place in the County of San Mateo on or about (date) ________________________ Please check the box or boxes that apply: Pursuant to Family Code §9200  I request permission to inspect my adoption records for the reasons set forth in the attached declaration. I understand that if my request is granted the name’s of my birth parents and any other information that might identify them shall be deleted from the documents or copies thereof.  I request copies of my adoption records for the reasons set forth in the attached declaration. I understand that if my request is granted the name’s of my birth parents and any other information that might identify them shall be deleted from the documents or copies thereof. You must attach a detailed declaration stating the reasons for your request. If you checked both boxes above you must provide a separate declaration for each request. AFFIDAVIT OF VERIFICATION I am the applicant in the foregoing matter. I have read the foregoing application and know the contents thereof. I certify or declare under penalty of perjury that the foregoing is true and correct. __________________________________________ Print Name _______________________________________ Signature Executed this ___________ day of ________________ 20____ at _______________________________ ADOPT-7 (updated 3-30-11) page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com