JDF 532 R 3 /1 8 REQUEST FOR ACCESS TO ADOPTION RECORDS Page 1 of 3 District Court Juvenile Court County, Colorado Court Address: In the Matter of the Adoption of: Birth Name of Adoptee (If known) Current Legal Name of Adoptee COU RT USE ONLY Attorney or Party Without Attorney (Name and Address): Phone Number: E - mail: FAX Number: Atty. Reg. #: Case Number: Division Courtroom REQUEST FOR ACCESS TO ADOPTION RECORDS I, , (name) request access to all adoption records as defined by section 19 - 1 - 103(6.5) (a.5) ,C.R.S., in the court possession, that may include : the original and amended birth certificate, the Final Decree of Adoption, the Final Order of Relinqui shment , the Order of Termination of P arental Rights , non - identifying information about the birth parents and adoptee, and identifying information about the birth parents and adoptee . 1. Information about the person making the request (Requestor) : Name: Date of Birth : Relationship to Adoptee: Street Address : Mailing Address, if different: City: State: Zip Code: Daytime Phone #: Email Address: Evening Phone #: 2. Information regarding the A doption: Name of Adoptive Parent(s): Date of Adoption (on or about): County of Adoption: 3. I am eligible to have access to the adoption records in this case because I am: a. The adul t adoptee OR His/her legal representative b. An adoptive parent of the minor adoptee OR His/her legal representative c. A custodial grandparent of the minor adoptee OR His/her legal representative d. The spouse or partner in a civil union of the adult ad optee OR His/her legal representative AND I have notarized written consent from the adult adoptee or proof that the adult adoptee is deceased American LegalNet, Inc. www.FormsWorkFlow.com JDF 532 R 3 /1 8 REQUEST FOR ACCESS TO ADOPTION RECORDS Page 2 of 3 e. An adult descendant of the adoptee OR His/her legal representative AND I have notarized written consent fro m the adult adoptee or proof that the adult adoptee is deceased f. An adult sibling or half - sibling of the adult adoptee OR His/her legal representative AND I have notarized written consent from the adult adoptee or proof that the adult adoptee is dece ased g. An adoptive parent or grandparent of an adult adoptee OR His/her legal representative AND I have notarized written consent from the adult adoptee or proof that the adult adoptee is deceased NOTE: You will be required to provide proof of your i dentity and establish your relationship to the adoptee to receive adoption records pursuant to section s 19 - 5 - 305(2)(b)(I) and (IV) , C.R.S . Ask the court for more details or click here for a list of acceptable forms of identification and documents to establish how you are related to the adoptee. If you are submitting your request by mail, please send copies of these documents to t he court for review (do not send originals). The court will destroy the copies after the information has been reviewed. If you send originals, y ou will be responsible for the cost of returning the originals to you by certified mail restricted delivery to ensure that the documents are delivered only to you . 4. I am not one of the individuals listed above in number 3 or do not have the required proof , however, good cause exists to allow me to have access to the adoption records pursuant to section 19 - 1 - 309, C.R.S. (explain below). Note: If you checked this box , file the Order ( JDF 533 ) with the Court. 5. The provisions of the Indian Child Welfare Act apply to the adoptee as follows: 6. When the court locates the adoption records that I am requesting, I request: T hat the court mail the records to me by certified mail restricted delivery (you will be responsible for the cos t of mailing); OR T hat the court notify me when the records are available , and I will come to the court in person to inspect and/or copy the records (you will be responsible for any copying costs). By checking this box, I am acknowledging I am f illing in the blanks and not changing anything else on the form. By checking this box, I am acknowledging that I have made a change to the original content of this form. American LegalNet, Inc. www.FormsWorkFlow.com JDF 532 R 3 /1 8 REQUEST FOR ACCESS TO ADOPTION RECORDS Page 3 of 3 VERIFICATION AND ACKNOWLEDGEMENT I swear/affirm under oath that I have read the foregoing Request and that the statements set forth therein are true and correct to the best of my knowledge. (Printed name of Requestor) Signature of Requestor Signed and sworn to before me by in the County of , State of , this , day of , 20 . My Commission Expires: Deputy Clerk/Notary Public FOR CLERK USE ONLY BELOW THIS LI NE (check the boxes below) The requesting party has presented: Identification provided: AN D D ocumentation establishing his/her relationship to the adoptee provided: If the request was received by mail: Copies of the documents described above received from the requestor proving identify and establishing his/her relationship to the adoptee were reviewed and destroyed on (dat e). If originals of the d ocuments described above were received from Requestor , the originals were returned to the Requestor by certified mail restricted delivery on(date). The certified mail receipt was received by the c ourt on (date). Tracking number: . NOTE: After the receipt is received and the tracking number is noted on the form, destroy the receipt. Clerk Signature Date American LegalNet, Inc. www.FormsWorkFlow.com