ADOPT-330 Request for Appointment of Confidential Intermediary Clerk stamps date here when form is filed. Use this form if you are seeking contact with your sibling who is not currently a dependent of the court and one of you has been adopted. If your sibling is currently a dependent of the court, you must follow the procedure in Welfare and Institutions Code section 388(b) instead of using this form. Before completing this form, you must ask for contact with your sibling from the department or licensed adoption agency that joined in your adoption or your sibling's adoption. If you do not know the name of the department or agency, ask the California Department of Social Services, Adoption Support Unit, 916-651-8088. After filling out this form, bring it and a blank copy of the proposed Order (ADOPT-331) to the clerk of the court where the adoption was finalized. After the court signs the order, a copy of this Request and the Order will be forwarded to the California Department of Social Services or the adoption agency, as designated by the court, and copies will be given to you. 1 I am asking the court to appoint a confidential intermediary to help me get contact information for my sibling. a. My name: b. My address: c. My phone number: a. The person helping me complete this request for the appointment of a confidential intermediary is: (1) Name: My attorney (State Bar No. ) My guardian ad litem (2) Address: (3) Phone number: I do not have an attorney or guardian ad litem who is helping me complete this request for the appointment of a confidential intermediary. An attorney used to represent me. a. Name of former attorney: b. Address of attorney: c. Phone number of attorney: d. This attorney used to represent me because: Fill in court name and street address: Superior Court of California, County of Clerk fills in case number when form is filed. Case Number: 2 b. 3 4 The department or the licensed adoption agency that joined in the adoption petition for: me my sibling a. Name of agency: b. Address: c. Phone number: Judicial Council of California, www.courtinfo.ca.gov New January 1, 2008, Mandatory Form Code of Civil Procedure, § 373 Family Code, § 9205 Cal. Rules of Court, rule 5.410 Request for Appointment of Confidential Intermediary ADOPT-330, Page 1 of 2 American LegalNet, Inc. www.FormsWorkflow.com Case Number: Your name: 5 The sibling whom I would like to contact is: a. My sibling's name: b. My sibling's current address (if known): c. My sibling is under the age of 18 years. (1) My sibling currently lives with (name and relationship to my sibling, if known): (1) My sibling used to live with (name and relationship to my sibling, if known): 6 7 8 My sibling was adopted in this county: Yes No Unknown Yes No Unknown My sibling was previously a dependent of the court in this county: The following are true (check all that apply): a. b. c. d. I submitted a written California Department of Social Services waiver form AD 904A or AD 904B to the agency listed in 4 before I completed this form. The agency in 4 sent a letter to me stating that no waiver for my sibling is in its file. A copy of the letter from the agency is attached to this request. I am asking the court to appoint a confidential intermediary to help me get contact information for my sibling. I am under the age of 18 years. (1) My parent/guardian signed a consent giving me permission to contact my sibling: (2) The court signed a consent giving me permission to contact my sibling: Yes My sibling is under the age of 18 years. To the best of my knowledge, there is not now, and never has been, an order stating that I cannot have contact with the sibling named in 5 . Yes No No e. f. 9 Any other information that would be helpful to the court: I declare under penalty of perjury under the laws of the State of California that the information in items 1 through 9, and in all attachments, is true and correct, which means that if I lie on this form, I am committing a crime. Date: Type or print your name Person who helped the applicant complete the form: Date: Type or print name Signature Attorney New January 1, 2008 Sign your name Guardian ad litem ADOPT-330, Page 2 of 2 Request for Appointment of Confidential Intermediary