ATTORNEY OR PARTY (Name and Address): TELEPHONE NO.: FOR COURT USE ONLY ATTORNEY FOR (NAME): SUPERIOR COURT OF CALIFORNIA, COUNTY OF ORANGE STREET ADDRESS: 341 THE CITY DRIVE MAILING ADDRESS: P.O. BOX 14171 CITY AND ZIP CODE: ORANGE, CA 92863-1571 Case Name: REQUEST FOR RELEASE OF CONFIDENTIAL ADOPTION AND/OR RELATED INFORMATION AND ORDER Case Number: (YOU MUST PROVIDE A VALID COPY OF YOUR GOVERNMENT ISSUED IDENTIFICATION WITH THIS REQUEST. NO FEE IS REQUIRED.) 1. Case Number: _______________________________________ NOTE: If case number (starting with "A" or "AD") is furnished, no need to complete items 4, 5, and 6 below. Adopted name of child: ________________________________________________________________ Name of child prior to adoption: _________________________________________________________ 2. 3. 4. Name of adoptive parents: ______________________________________________________________ 5. Name of natural parents: _______________________________________________________________ 6. Approximate date of adoption in Orange County: Month ____ Day ____ Year ____ 7. Approximate birth date of child: Month ____ Day ____ Year ____ 8. I am the: Adoptive father/mother Natural father/mother Adopted child Other: ______________________________________________________ 9. I desire: Certified copy of adoption decree Other: ______________________________________________________ REQUEST FOR RELEASE OF CONFIDENTIAL ADOPTION AND/OR RELATED INFORMATION AND ORDER L-1310 (Rev. 09/11) FC 9200 American LegalNet, Inc. www.FormsWorkFlow.com 10. Name(s) of person(s) submitting request: Present Name: ___________________________________________________________________________________ Former Name: ___________________________________________________________________________________ 11. Telephone number of person making request: _________________________________________________________ 12. STOP HERE if you are the adoptive parent, attorney of record, or an employee of the Social Services/Probation Dept. 13. If you are not a person listed on Item 12, the Clerk must have written authority of the Court before providing information. The Court will not give such authorization except in "exceptional circumstances" (Family Code 9200) Explain here the reason(s) you require the information requested: _________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Dated: _____________________, 20___. ___________________________________________ Signature NOTE: In the case of request by adoptive parent, this signature will be compared with that in the adoption petition before any release of information. __________________________________________________________________________________________________ Based upon the circumstances outlined above, the court orders: Authority is granted to the Clerk to release adoption information to the person requesting. Request is denied. Dated: ___________________________________ ___________________________________________ JUDGE OF THE SUPERIOR COURT REQUEST FOR RELEASE OF CONFIDENTIAL ADOPTION AND/OR RELATED INFORMATION AND ORDER L-1310 (Rev. 09/11) FC 9200 American LegalNet, Inc. www.FormsWorkFlow.com