REQUEST FOR COPIES OF A FINAL DECREE OF ADOPTION ENTERED LESS THAN SIX (6) YEARS AGO $6.50 PER COPY OF DECREE FOR CERTIFICATION AND COPYING NO FILING FEE MONEY ORDER (VIA MAIL) CASH OR MONEY ORDER (IN PERSON) PLEASE BRING OR MAIL COMPLETED FORM & ADDITIONAL COPY WITH PAYMENT TO: DC SUPERIOR COURT FAMILY COURT CENTRAL INTAKE CENTER 500 INDIANA AVE NW JOHN MARSHALL LEVEL ROOM 520 WASHINGTON, DC 20001 FOR FURTHER INFORMATION PLEASE CALL 202 879-1411 OR 202 879-4335 American LegalNet, Inc. www.FormsWorkflow.com SUPERIOR COURT OF THE DISTRICT OF COLUMBIA FAMILY COURT - ADOPTIONS REQUEST FOR A COPY OF THE FINAL DECREE OF ADOPTION* THIS FORM MUST BE NOTARIZED * YOU MUST BE THE ADOPTEE OR AN ADOPTIVE PARENT TO USE THIS FORM. IF THE FINAL DECREE OF ADOPTION WAS ENTERED MORE THAN SIX (6) YEARS PRIOR TO THIS REQUEST DATE, YOU MUST FILE A PETITION TO BREAK THE SEAL OF ADOPTION I, _____________________________, am requesting copies of a Final Decree of Adoption. PRINT YOUR NAME 1. I state that I am the adoptee. I am the adoptive parent. Other. STOP, please complete the form to file a Petition to Break the Seal of Adoption 2. Today’s date is ________________________________________ (MM/DD/YYYY) To the best of my knowledge, the date of the Final Decree of Adoption was: ____________________________ and this date is less than 6 years from today’s date. (MM/DD/YYYY) (If the final decree of adoption was entered more than 6 years ago, please complete the form to file a Petition to Break the Seal of Adoption) {1} American LegalNet, Inc. www.FormsWorkflow.com 3. The name of the adoptee (if known) is ___________________________________________________________ BIRTH NAME OF ADOPTEE ________________________________________ ADOPTED NAME OF ADOPTEE 4. The date of birth of the adoptee is ________________________________________ (MM/DD/YYYY) 5. The adoption case number (if known) is ________________________________________ 6. The names of the ADOPTIVE parents and their dates of birth (if known) are ________________________________________ NAME OF ADOPTIVE PARENT ONE ________________________________________ ADOPTIVE PARENT ONE DATE OF BIRTH (MM/DD/YYYY) ________________________________________ NAME OF ADOPTIVE PARENT TWO ________________________________________ ADOPTIVE PARENT TWO DATE OF BIRTH (MM/DD/YYYY) 7. I am requesting ______ copies of the Final Decree of Adoption. 8. I am submitting $________ in fees. ($6.50 per copy for certification and copying. Payment by mail must be by money order) {2} American LegalNet, Inc. www.FormsWorkflow.com I, __________________________, solemnly swear or affirm under criminal penalties for the making of a false statements that I have read the Request For a Copy of the Final Decree of Adoption and that the factual statements made in it are true to the best of my knowledge, information, and belief. ____________________________ SIGN YOUR NAME __________________________________________ DATE (MM/DD/YYY) __________________________________________ STREET ADDRESS __________________________________________ CITY, STATE, AND ZIP CODE ___________________________________________ TELEPHONE NUMBER _____________________________, being first sworn under oath, and having provided photographic identification, states that the statements made in the Request For a Copy of the Final Decree of Adoption are true to the best of his/her knowledge and belief. ______________ Date __________________________________ Deputy Clerk/Notary Public Subscribed and sworn to before me on ______________________________. _________________________________ Deputy Clerk/Notary Public {3} American LegalNet, Inc. www.FormsWorkflow.com