Name : Address : 1 2 3 4 5 6 7 8 9 10 11 12 City/State/Zip Code : Telephone Number : SUPERIOR COURT OF CALIFORNIA COUNTY OF SAN FRANCISCO UNIFIED FAMILY COURT ) ) Case No.: ) ) Application and Order ) RE: Release of Adoption Records ) ) ) ) ) IN THE MATTER OF: ________________________ Adopted minor's name I am the: 13 14 15 16 17 _______Birth Parent _______Adoptive Parent _______Person previously-adopted For the reasons set forth below, permission is here by sought; 18 19 20 _______To determine the existence and/or status of any filed Petition or Request for Adoption involving the above-named individual: _______To Obtain a certified copy of decree: 21 22 23 24 25 26 27 28 29 _______other: Other name by which adopted child is/was known: Name of adoptive parents: Date of adoption: ______________________Case Number: _____________________ Page 1 Electronic format by: A. Birdsong 12.3.08 American LegalNet, Inc. www.FormsWorkflow.com 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 In the Matter of: _____________________________ Case Number: ____________________ Family Code Section 9200 prohibits release of any adoption information "except in exceptional circumstances and for good cause approaching the necessitous". Reason for request and facts in support of request (attach corroborative documents, if appropriate): I declare under penalty of perjury that the foregoing is true and correct: Date: ______________________ Signature: ____________________________________ Print name: ___________________________________ See next page for Declarations outside the State of California. Page 2 Electronic format by: A. Birdsong 12.3.08 American LegalNet, Inc. www.FormsWorkflow.com 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 In the Matter of: _____________________________Case Number: _____________________ *Note: The form of declaration under penalty of perjury is to be used only when executed in the State of California. If this document is executed outside the State of California, this form is to be executed before a Notary Public or other officer authorized to administer oaths. Subscribed and sworn to and before me on: ________________________________ (Seal) __________________________________Notary Public ORDER _______The request for disclosure of adoption information is hereby denied. There is insufficient showing as required by Family Code Section 9200. _______Good cause appearing, the request for disclosure of adoption information is hereby granted. The Court finds, in balancing the rights of all concerned individuals, that exceptional circumstances exist necessitating the release of the information herein requested. The information herein requested shall be released to the requesting party. Date: ___________________ // // // // // // ________________________________________ Judge of the Superior Court Print Form 29 Page 3 Electronic format by: A. Birdsong 12.3.08 Clear Form American LegalNet, Inc. www.FormsWorkflow.com