PETITION AND ORDER RE ADOPTION RECORDS (SC-AD-1) Name:_______________________________ Address:____________________________ ____________________________________ Telephone:__________________________ SUPERIOR COURT OF CALIFORNIA FOR THE COUNTY OF SISKIYOU In the Matter of the Adoption of _____________________________________, (Name) ) ) ) ) CASE NO._________________ PETITION TO INSPECT ADOPTION RECORDS; AND ORDER THEREON ) __________________________________________) Petitioner respectfully represents: 1. I, _________________________, am the ___________________________________________ (Print Name of Petitioner) (Relationship to Parties in This Matter, if Any) 2. On _______________________, a decree of adoption was entered in this matter, (Date) decreeing ____________________________________________________________________ (Name of Adoptee) to be the adopted child of ___________________________________________________. (Name/s of Adoptive Parent/s) 3. Other name/s by which the adoptee is or has been known__________________________. 4. For reasons set forth below, permission is hereby sought: 5. to determine whether an action has been filed for the adoption of the party named above. to obtain a certified copy of the adoption decree. to obtain an undeleted copy of the adoption file. Reason for request: Medical necessity (declaration attached). Other extraordinary circumstances, and for good cause approaching the necessitous (declaration attached). Other:___________________________________________ (declaration attached). WHEREFORE, petitioner prays for an order directing the clerk of the Court to allow inspection and copying by petitioner of the confidential court records in this matter, including the names of the birth parents. Date:_____________________ __________________________________ PETITIONER Mandatory Form Rev. 7/1/04 PAGE 1 OF 2 American LegalNet, Inc. www.FormsWorkFlow.com LOCAL RULES OF THE SISKIYOU COUNTY SUPERIOR COURT SC-AD-1, page 2 In Re the Adoption of:________________________________ No._____________________ Case VERIFICATION I,______________________________, am the petitioner in this proceeding. I have read the foregoing petition and know the contents thereof. The same is true of my own knowledge, except as to matters therein alleged on information and belief, and as to those matters, I believe them to be true. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date:________________________ ___________________________________ PETITIONER ORDER Upon consideration of the Application above, and with good cause appearing, permission is hereby granted to the above-named applicant to obtain the information and the services hereinabove set forth. The Court finds that the requirements of Family Code §9200 et.seq. have been met. The clerk of the Court is ordered to permit the inspection and copying of the file as prayed, upon payment by petitioner of the appropriate fees and costs. Date:________________________ ___________________________________ JUDGE OF THE SUPERIOR COURT CLERK'S CERTIFICATION The undersigned declares: A search of the indices for adoption from ____________________ to _________________ has been made by the clerk, who finds no records in this office pertaining to the adoption of ______________________________. CLERK OF THE SUPERIOR COURT Siskiyou County, California Date:________________________ By:_________________________________ Deputy Mandatory Form Rev. 7/1/04 PAGE 2 OF 2 American LegalNet, Inc. www.FormsWorkFlow.com