VN200 ATTORNEY OF PARTY WITHOUT ATTORNEY (Name and Address) Telephone Number FOR COURT USE ONLY ATTORNEY FOR (Name): SUPERIOR COURT OF CALIFORNIA, COUNTY OF VENTURA 4353 E. VINEYARD AVE, OXNARD, CA. 93036 In the Matter of the Petition of : CASE NUMBER: PETITION AND AUTHORIZATION TO INSPECT ADOPTION AND BIRTH RECORD INFORMATION AND TO OBTAIN COPIES; TRANSMITTAL [FAMILY CODE §9200 AND HEALTH AND SAFETY CODE 102705] I am the Petitioner and submit the following: 1. My name is__________________________________________________________________________________. 2. My mailing address is__________________________________________________________________________. 3. My residence address is _______________________________, County of _______________________________. 4. My telephone number is________________________________________________________________________. 5. My birth date is_______________________________________________________________________________. 6. I am now _____________________ years old. 7. (Check one) I am informed and I believe that I was adopted by ________________________________________________ (adopting parent(s) on or about _____________________________________, in the County of Ventura. OR I am informed that an adoption proceeding related to ______________________________________________ (adoptee) was completed in the County of _______________________________________________, on or about _______________________ by ________________________________________ (adopting parents). 8. (Family Code §9200) I request permission to inspect the records and/or obtain copies of the records contained in the court file relating to the adoptee ___________________________________, for the following reasons: (Family Code §9200 requires a showing of exceptional circumstances and good cause approaching the necessitous.) ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ (Attach additional pages if needed.) Mandatory Form VN200 (01/10) PETITION FOR AUTHORIZATION TO INSPECT ADOPTION AND BIRTH RECORD INFORMATION AND TO OBTAIN COPIES Page 1 of 4 American LegalNet, Inc. www.FormsWorkFlow.com VN200 Short Title: Case Number: 9. (Health and Safety Code §102705) I request permission to inspect and/or copy the original birth record contained in the State Department of Social Services files for the following reasons: ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ (Attach additional pages if needed.) (Health and Safety Code § 102705 requires a showing of necessity of the order and good and compelling cause. The name and address of the natural parents shall be given to the petitioner only if he or she can demonstrate that the name and address, or either of them, are necessary to assist him or her in establishing a legal right.) 10. For the reasons stated, I request permission to obtain to inspect a copy of the following document(s): a. ____________________________________________________________________________ b. ____________________________________________________________________________ c. ____________________________________________________________________________ d. ____________________________________________________________________________ 11. Attached is a copy of a government issued current photographic identification card of the petitioner. I request an order of the Superior Court as required by Family Code section 9200 and/or Health and Safety Code section 102705 with respect to the records relating to the above proceeding. Date:______________________ ____________________________________________ Signature of Petitioner VERIFICATION I am the petitioner in the above matter. I have read this petition and I know and understand what it states. I declare that the petition is true based upon my own personal knowledge, except as to those matters where it is stated to be based upon my 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 above is true and correct. Dated: ____________________ Location of signing: __________________________ ____________________________________________ Signature of Petitioner Mandatory Form VN200 (01/10) PETITION FOR AUTHORIZATION TO INSPECT ADOPTION AND BIRTH RECORD INFORMATION AND TO OBTAIN COPIES Page 2 of 4 American LegalNet, Inc. www.FormsWorkFlow.com VN200 TRANSMITAL TO BE COMPLETED AND SENT BY CLERK OF THE COURT TO SACRAMENTO ONLY IF PARAGRAPH 9 OF THE PETITION HAS BEEN CHECKED (Health and Safety Code §102705) STATE DEPARTMENT OF SOCIAL SERVICES Adoptions Branch 744 P Street, M/S 19-31 Sacramento, CA 95814 To California State D.S.S.: The original petition seeking original birth records pursuant to Health and Safety Code section 102705 was filed in the Ventura County Superior Court on ________________________________. Please comply with Health and Safety Code section 102705 by sending to the Ventura County Superior Court, attention: Adoptions Clerks, a copy of all records and information it has concerning the adopted person __________________________________________________________with the name and address of the natural parents removed. Executive Officer/Clerk of the Superior Court of Ventura County Dated: ____________________ _______________________________________________ Deputy Clerk (A copy of this request was sent by the Clerk of the Court to the Department of Social Services on _____________________________________________) (Upon receipt of records from Department of Social Services, to be completed by Clerk of Court) To the Judge of Ventura County Superior Court: Attached are the records received by Clerk of the Court from the State Department of Social Services in response to this verified petition. Executive Officer/Clerk of the Superior Court of Ventura County Dated: ______________