D.R.L. §114 Adoption Form 14 (Certificate of Adoption) (9/2005) COURT OF THE STATE OF NEW YORK COUNTY OF CERTIFICATE OF ADOPTION I, Court of this Court and find that: , Clerk of the County, do hereby certify that I have inspected the records of AN ORDER OF ADOPTION was signed on the day of , , by Honorable , Judge of the Court of the County of , granting the petition of (and ), adoptive parent(s) of a child now known and called by the name of [specify]: , who was born at , on the day of , ; This certificate as to the facts recited herein shall have the same force and effect as a certified copy of an order of adoption. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of the Court of the County of this day of , . ________________________________ Clerk of the Court of the County of American LegalNet, Inc. www.USCourtForms.com