SUPERIOR COURT OF CALIFORNIA COUNTY OF SANTA CRUZ 1 Second Street, Room 301 Watsonville, CA 95076 Watsonville Branch FOR COURT USE ONLY IN THE MATTER OF : CERTIFICATE OF ADOPTION CASE NUMBER: Form Adopted for OPTIONAL USE Superior Court of Santa Cruz County SUP ADOPT 050 01 / 01 / 19 CERTIFICATE OF ADOPTION Page 1 of 1 SUP ADOPT 050 Pursuant to the information in its records, the Court hereby certifies that an adoption took place as follows: 1. 2. 3. Date of Adoption: 4. Place of Adoption: 5. Name of Adoptive Father: 6. Name of Adoptive Mother: I am a clerk of the Superior Court of California, County of Santa Cruz, and I am not a party to this case. I certify that the foregoing information is true and correct. Dated: Clerk, by Deputy Clerk American LegalNet, Inc. www.FormsWorkFlow.com