Notice Of Adoption And Medical History
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Notice Of Adoption And Medical History Form. This is a Nebraska form and can be use in County Court-Separate Juvenile Court Statewide.
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Tags: Notice Of Adoption And Medical History, 17-5, Nebraska Statewide, County Court-Separate Juvenile Court
COURT
COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
......... ..
:
STATE OF NEBRASKA
FORM NO. 17:5 1/91 NEW
Sec. 43-107
Index No.
NOTICE OF ADOPTION No.
:
Calendar
MEDICAL HISTORY
Plaintiff(s)
:
CASE NUMBER
JUDICIAL SUBPOENA
:
IN THE ________________ -against- OF _____________________________COUNTY, NEBRASKA
COURT
:
In the Matter of the Adoption of
:
Defendant(s)
:
......................................................
NOTICE OF ADOPTION
MEDICAL HISTORY
_________________________________________,
THE PEOPLE OF THE STATE OF NEW YORK
Notice to:
TO Bureau of Vital Statistics
P. O. Box 95007
Lincoln, Nebraska 68509-5007
GREETINGS: advised that on __________________, ______ I have determined that in the adoption of
You are
WE COMMAND YOU, that all business and excuses being laid
_______________________________________________: aside, you and each of you attend before
,
the Honorable
at the
Court
(new adoptive name)
located at
County of
in room The medicalthe
, on history of the biological father is ,unavailable.
day of
, 20
at
o'clock in the
noon, and at any recessed
or adjourned date, to testify and of the biologicalamother is unavailable. the part of the
give evidence as witness in this action on
The medical history
Y
Y
Y
This is a step-parent adoption; the court has determined that a medical history is not required in
this failure
Yourcase. to comply with this subpoena is punishable as a contempt of court and will make you liable to
the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a
______________________________________________________________________
result of your failure to comply.
Y
______________________________________________________________________
Witness, Honorable
, one of the Justices of the
______________________________________________________________________
Court in
County,
day of
, 20
______________________________________________________________________
______________________________________________________________________
(Attorney must sign above and type name below)
Attorney(s) for
Office and P.O. Address
DATE:
BY THE COURT:
Telephone No.:
Facsimile No.:
E-Mail Address:
(Clerk)
Mobile Tel. No.:
(Seal)
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