Domestic Relations Law §112-b Adoption Form 18 (Agency Adoption­ Order Determining Petition for Enforcement of Post -adoption Contact Agreement After Adoption Finalization) (8/2010) At a term of the Family Court of the State of New York, held in and for the County of , at New York, on , . P R E S E N T: Hon. Judge _____________________________________ In the Matter of a Post-adoption Contact Agreement Concerning Child's Name: Date of Birth: Pursuant to Section 112-b of the Domestic Relations Law _______________________________________ NOTICE: WILLFUL FAILURE TO OBEY THE TERMS AND CONDITIONS OF THIS ORDER MAY RESULT IN COMMITMENT TO JAIL FOR A TERM NOT TO EXCEED SIX MONTHS. The petition of [specify]: , dated [specify]: , having been filed requesting enforcement of a Post-adoption Contact Agreement, approved by the Family Court, County, and incorporated into the Order of Adoption by Order of Incorporation, dated [specify]: by the [specify]: G Family G Surrogate's Court, County; And all parties to the Post-adoption Contact Agreement, including the attorney for the child, having been duly served with notice of this proceeding and the following having personally appeared [specify]: And the matter having duly come on for a hearing before this Court, and the Court, after hearing the proof and testimony offered in relation to the case, having determined that [check applicable box]: G The following Respondent [specify]: Agreement as follows [specify]: violated the Post-adoption Contact Docket No. ORDER DETERMINING PETITION FOR ENFORCEMENT OF POST-ADOPTION CONTACT AGREEMENT (After Adoption Finalization) and enforcement of the Post-adoption Contact Agreement G is G is not in the child's best interests for American LegalNet, Inc. www.FormsWorkFlow.com Adoption Form 18 the following reasons [specify]: OR G The Post-adoption Contact Agreement has not been violated. NOW THEREFORE, it is Page 2 G ORDERED that the petition is GRANTED and the Post-adoption Contact Agreement is enforced. as follows [specify]: OR G ORDERED that the petition for enforcement of the Post-adoption Contact Agreement is DISMISSED. ENTER _____________________________________ Judge of the Family Court Dated: PURSUANT TO SECTION 1113 OF THE FAMILY COURT ACT, AN APPEAL FROM THIS ORDER MUST BE TAKEN WITHIN 30 DAYS OF RECEIPT OF THE ORDER BY APPELLANT IN COURT, 35 DAYS FROM THE DATE OF MAILING OF THE ORDER TO APPELLANT BY THE CLERK OF COURT, OR 30 DAYS AFTER SERVICE BY A PARTY OR THE ATTORNEY FOR THE CHILD UPON THE APPELLANT, WHICHEVER IS EARLIEST. Check applicable box: 9 Order mailed on [specify date(s) and to whom mailed ]:___________________________ 9 Order received in court on [specify date(s) and to whom given]:_____________________ American LegalNet, Inc. www.FormsWorkFlow.com