ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address): FOR COURT USE ONLY TELEPHONE NO.: EMAIL ADDRESS: ATTORNEY FOR (Name): STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME: FAX NO.: SUPERIOR COURT OF CALIFORNIA, COUNTY OF IN THE MATTER OF: APPLICATION TO OBTAIN FINAL ADOPTION ORDER AND ORDER CASE NUMBER: If you do not know the case number, enclose a $15.00 research fee plus a self-addressed stamped envelope for the return of the documents. If you are the original petitioner of the adoption, enclose a copy of your driver license. I, _____________________________________________, do hereby request the court for permission to obtain a copy or certified copy of the final adoption order as requested below: 1. 2. 3. 4. 5. Child's name: __________________________________________ Child's date of birth _____________________ City and State where the adoption took place:______________________________________________________ Date or approximate date of adoption: ___________________________ Type of adoption: _________________ Adopting parent's name: _______________________________________________________________________ Reason for the request: (may attach additional pages) ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ 6. Relationship to adopted individual: _______________________________________________________________ I declare under penalty of perjury under the laws of the State of California that the information above is true and correct. Date: ____________________________ Signature: ___________________________________________ ORDER Denied Set for Hearing: ______________________________________________________________ Good cause appearing therefore, permission is hereby granted the above named applicant to obtain a copy and/or certified copy of the final adoption order. Dated: __________________ Judge of the Superior Court __________________________________________ Form 13-21911-360 Rev 08/11/2016 APPLICATION TO OBTAIN FINAL ADOPTION ORDER AND ORDER Family Code §9200 American LegalNet, Inc. www.FormsWorkFlow.com