At a term of the Court of the State of New York, held in and for the County of ________, at ________, New York on _____________________, _____ P R E S E N T: Hon. ________________________ Judge _____________________________________ A Child Whose First Name Is File No. ORDER FOR CHILD PROTECTIVE INQUIRY __________________________________ UPON reading and filing of the petition for a private placement adoption, agreement of adoption, consents and other papers submitted herein, the Court finds pursuant to Social Services Law §422(4)(A)(e) that _____________________ is an adult member of the petitioner(s) household and that a report from the New York State Office of Children & Family Services as to whether s/he has a history of indicated child protective reports is necessary to determine whether the best interests of the child would be served by granting the adoption petition; NOW THEREFORE, it is hereby ORDERED that the New York State Office of Children & Family Services shall conduct an investigation/inquiry on _____________________, a person over the age of eighteen and a member of the prospective adoptive parent(s) household and submit the report to the _________ County Surrogate’s Court located at_____________________, ________, NY _______ within 30 days of this Order. Date: ____________________________ Hon.________________________ Surrogate Check applicable box: [ ] Order mailed on ____________________ and to whom mailed:__________________________ [ ] Order received in court on_____________and to whom given:________________________ Form 12/99 Order for Investigation American LegalNet, Inc. www.FormsWorkFlow.com