D.R.L. §§111-c Adoption Form 28-A (Order of Foreign Adoption and Name Change) 9/2008 At a term of the Family Court of the State of New York, held in and for the County of , at New York on , . PRESENT: Hon. Judge ____________________________________ In the Matter of the Adoption of A Child Whose First Name Is QDocket QFile No. ORDER OF FOREIGN ADOPTION (AND NAME CHANGE) ____________________________________ The Petition of ), verified the Adoption of [specify country]: having been presented to this Court, day of (and , , together with the Order of , dated [specify]: , This Court hereby finds and determines the following: 1. The names and states of residence of the adoptive parent(s) is/are [specify]: 2. The child [specify name]: was reported to have been born on [specify date]: 3. The child was adopted in [country]: in [country]: on [specify date]: 4. The child was granted an IR-3 immigrant visa by the United States Citizenship and Immigration Services on [specify date]: NOW, and upon all the papers and proceedings herein, it is ORDERED that the petition of (and ) for the registration of the adoption of [child’s name]: is GRANTED; and it is further ORDERED that the Order of Adoption issued in [country]: American LegalNet, Inc. www.FormsWorkflow.com Adoption Form 28-A Page 2 is registered in this State and is incorporated into and made a part of this Order and such Order of Adoption is deemed to have the same force and effect and is enforceable as if it had been issued by a court in the State of New York; and it is further ORDERED that the adoptive child shall be regarded and treated in all respects as the lawful child of the adoptive parent(s); and it is further ORDERED that the name of the adoptive child is changed to [specify]: that the adoptive child shall hereafter be known by that name; and it is further and [Check box if applicable]: Q ORDERED that the Clerk prepare, certify and deliver a copy of this order to [specify]: ; and it is further [Check box if applicable]: G ORDERED that, if required by a governmental agency, including but not limited to, the United States Social Security Administration, the United States Passport Office and the New York State Department of Motor Vehicles, in connection with an application submitted by or on behalf of the adoptive child, the adoptive parent(s)’ attorney [specify]: is authorized to deliver a certified copy of this Order of Foreign Adoption to such agency directly or to the adoptive parent(s), as he or she deems appropriate; and it is further ORDERED that this order, together with all other papers pertaining to the adoption, shall be filed and kept as provided in the Domestic Relations Law and shall not be subject to access or inspections except as provided in this Order or by such Law. ENTER: ______________________________ 9 Judge of the Family Court 9 Surrogate Dated: , . [Applicable to orders of the Family Court]: PURSUANT TO SECTION 1113 OF THE FAMILY COURT ACT, AN APPEAL FROM AN ORDER OF THE FAMILY COURT 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 LAW GUARDIAN 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