JDF 345 R8 / 15 ORDER OF APPOINTMENT OF CONFIDENTIAL INTERMEDIARY AND ORDER TO Page 1 of 2 RESCIND APPOINTMENT OF CONFIDENTIAL District Court Denver Juvenile Court County, Colorado Court Address: I n the Matter of the Adoption of or Personal Juvenile Records of : (Birth name of adoptee, if known) and concerning : (Current legal name) , Petitioner COURT USE ONLY Case Number : Division Courtroom ORDER OF APPOINTMENT OF CONFIDENTIAL INTERMEDIARY AND ORDER TO RESCIND APPOINTMENT OF CONFIDENTIAL INTERMEDIARY Following a review of the Motion in this case, the Court orders that the C onfidential I ntermediary be appointed to conduct a search for the birth relatives or other persons as designated by 247 19 - 5 - 301, et seq., C.R.S , on behalf of the P etitioner. T he c onfidential intermediary will fil e the Oath or Affirmation of Confidentiality with the Court . The appointed confidential intermediary is authorized to inspect confidential relinquishment, termination, juvenile personal records, and adoption records in thi s Court, other courts, and any public or private hospitals, maternity homes, adoption agencies, and state or public agencies that have information concerning this case. Such appointment extends for 270 days from the date of appointment of the confidenti al intermediary. The confidential intermediary shall file a the Court within 270 days of designation unless an application is made to the Court for an extension of time for good ca use. To be completed by the judge : The confidential intermediary designee is: (name) Date: Judge Magistrate CERTIFICATE OF MAILING I certify that on (date), I mailed, faxed, or hand - delivered a copy of this Order to the following: Attorney for Petitioner(s) or Petitioner(s) pro se Confidential Intermediary Appointed by the Court Other: Clerk American LegalNet, Inc. www.FormsWorkFlow.com JDF 345 R8 / 15 ORDER OF APPOINTMENT OF CONFIDENTIAL INTERMEDIARY AND ORDER TO Page 2 of 2 RESCIND APPOINTMENT OF CONFIDENTIAL The above - named designee has been withdrawn as the confidential intermediary for this case. Date withdrawn : . I certify that I have mailed a copy of the withdrawal to the petitioner named above. Date: Clerk American LegalNet, Inc. www.FormsWorkFlow.com