JDF 340A R 1 - 1 8 OATH OR AFFIRMATION OF CONFIDENTIALITY BY CONFIDENTIAL INTERMEDIARY District Court Denver Juvenile Court County, Colorado Court Address: IN THE MATTER OF THE ADOPTION OF: AND CONCERNING : , Petitioner COURT USE ONLY Attorney or Party Wi thout Attorney (Name and Address): Phone Number: E - mail: FAX Number: Atty. Reg.#: Case Number: Division Courtroom OATH OR AFFIRMATION OF CONFIDENTIALITY REGARDING M OTION TO OPEN ADOPTION AND RELINQUISHMENT FILES I, , declare under oath or affirm that: My current address is: . (Street Address, City, State, Zip) My current telephone numbers are: (Home) (Work) I agree, until further written notice to the Court, to accept appointment as a confidential i ntermediary in cases where the petitioner is seeking to find birth relatives. I state that I am not seeking appointment on behalf of a relative, friend, business asso ciate, or other individual that could constitute a conflict of interest. I affirm that: 1. Any information I obtain during the course of my investigation shall be kept strictly confidential and shall be used only for the purpose of arranging a contact between the individual who initiated the search and the sought - after biological relative or for release of information pursuant to 24719 - 5 - 305(2)(a)(II) and (2)(c)(I), C.R.S.; 2. When a sought - after biological relative is located on behalf of the petitioner, I shall obtain consent from both parties that they wish to personally communicate with one anoth er or for release of information pursuant to 24719 - 5 - 305(2)(a)(II) and (2)(c)(I), C.R.S.; 3. Contact shall be made between the petitioner and sought - after party only when consent for such contact has been received by the Court; 4. If consent for personal communi cation is not obtained from both parties, all relinquishment and adoption records and any other information I obtained shall be returned to the Court and shall remain confidential, except as provided by 24719 - 5 - 305(2)(a)(II) and (2)(c)(I), C.R.S.; and 5. If ap pointed by the Court as a confidential intermediary, I will make no unreasonable charges for my services, and will include a copy of my itemized fees and expenses in my report to the Court. VERIFICATION I declare under penalty of perju ry under the law of Colorado that the foregoing is true and correct. Executed on the day of , , at (date) (month) ( year) (city or other location, and state OR country (printed name of Confidential Intermediary ) Signature of Confidential Intermediary American LegalNet, Inc. www.FormsWorkFlow.com