IN THE CIRCUIT COURT IN THE EIGHTEENTH JUDICIAL CIRCUIT IN AND FOR BREVARD COUNTY, FLORIDA. Case No.: Bar Code Label IN RE: TERMINATION OF PARENTAL RIGHTS PENDING STEPPARENT ADOPTION OF , Minor Child(ren) ORDER FOR SEARCH AND CERTIFICATE OF SEARCH PUTATIVE FATHER REGISTRY Upon motion of Petitioner for search of the Florida Putative Father Registry by the Bureau of Vital Statistics and request for issuance of a certificate of search, the Court finds that a showing of good cause has been made in support of the motion, therefore, it is ORDERED that the Bureau of Vital Statistics shall search the Florida Putative Father Registry for the minor child(ren): _________________________ _________________________ _________________________ _________________________ date of birth: date of birth: date of birth: date of birth: ____________ ____________ ____________ ____________ place of birth: place of birth: place of birth: place of birth: _____________________ _____________________ _____________________ _____________________ The mother’s name is _________________________________________________________________ and her place of birth is _______________________________________________________________. The mother’s maiden name is _____________________________________ and her current address is __________________________________________________________________________________. The Clerk of Court shall issue a Certified Copy of this order to the Petitioner upon request. Upon completion of this search the Bureau of Vital Statistics shall issue a Certificate of Completion and send this certificate to the Petitioner, __________________________________________, at the address ________________________________________________________________________. DONE AND ORDERED in Brevard County, Florida, on {date} ____________________, 20___. ____________________________________ Circuit Judge COPIES TO: Petitioner (or his/her attorney) Respondent (or his/her attorney) Law 1079 - Rev. 06/2007 American LegalNet, Inc. www.FormsWorkflow.com