ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar Number, Address) Reserved for Clerk's Office Stamp TELEPHONE NO: E-MAIL ADDRESS (Optional): ATTORNEY FOR (Name): FAX NO.(Optional): SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN MATEO Youth Services Center, Juvenile Court 222 Paul Scannell Drive San Mateo, CA 94402 IN RE: CASE NUMBER: REQUEST TO OBTAIN INFORMATION FROM SUPERIOR COURT ADOPTION FILE ADOPTEE - FAMILY CODE SECTION 9200 My name is: ___________________________________________________________________ Date of Birth: _______________________ Phone number: _____________________________ Address: _______________________________________________________________________________________ Email Address ________________________________________________ I am informed and believe that I was adopted by: Mother ______________________________________ (complete first and last name) Father __________________________________________ (complete first and last name) The adoption took place in the County of San Mateo on or about __________________________________________ (month-date-year) Type of adoption: ____ Step Parent ____ Independent ____ County ____ Agency ____ Adult Please check the box or boxes that apply: I request permission to inspect my adoption records for the reasons set forth in the attached declaration. I understand that if my request is granted the names of my birth parents and any other information that might identify them shall be deleted from the documents or copies thereof. I request copies of my adoption records for the reasons set forth in the attached declaration. I understand that if my request is granted the names of my birth parents and any other information that might identify them shall be deleted from the documents or copies thereof. You must attach a detailed declaration stating the reasons for your request. If you checked both boxes above you must provide a separate declaration for each request. Include a self- addressed stamped envelope if you wish to receive a copy of the final order, standard copy and certification charges will apply. Page 1 of 2 Form adopted for Mandatory Use Request Local Court Form Adopt-7 [Revised Sept. 2012] To Obtain Information from Court Adoption Files ­ Adoptee Fam.C. § 9200 www.sanmateocourt.org American LegalNet, Inc. www.FormsWorkFlow.com AFFIDAVIT OF VERIFICATION * I am the applicant in the foregoing matter. I have read the foregoing application and know the contents thereof. I certify or declare under penalty of perjury that the foregoing is true and correct. __________________________________________ Print Name _______________________________________ Signature Executed this ___________ day of ________________ 20____ at _______________________________ * If this document is executed outside of the State of California, the affidavit of verification is to be executed before a notary public or other officer authorized to administer oaths. Page 2 of 2 Form adopted for Mandatory Use Request Local Court Form Adopt-7 [Revised Sept. 2012] To Obtain Information from Court Adoption Files ­ Adoptee Fam.C. § 9200 www.sanmateocourt.org American LegalNet, Inc. www.FormsWorkFlow.com