D.R.L.§§ 111(3), S.C.P.A. 307(2)(a) (iv),CPLR 315 Form 5 (Order of Publication Agency) 9/99 At a term of the 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 Docket No. ORDER OF PUBLICATION __________________________________________ Upon reading and filing the petition herein duly verified on applying for the adoption of the above-named person and upon the affidavit of duly sworn to on and it appearing to the satisfaction of the Court that the present whereabouts of are unknown and cannot, after due diligence, be ascertained, it is hereby ORDERED, that service of a copy of a notice of application for adoption be made upon by publication thereof in (one) (two) newspaper(s), to wit: in the published in the County of , State of (and in the published in the County of 1 State of , (once) (not less than once in each of four successive weeks)2, the (first) publication to be made at least days before the return day fixed in the said notice of application for adoption; and it is further (ORDERED that on or before the day of first publication the petitioner deposit in a post office or in any post office box regularly maintained by the government of the United States in the State of New York a copy of said notice of application for adoption, contained in a securely closed, post-paid wrapper, directed to 1 S.C.P.A. § 307(2)(a)(iv) 2 CPLR 315 et seq American LegalNet, Inc. www.USCourtForms.com Form 5 page 2 said at that being last known address of said person.) (ORDERED that the mailing of said notice of application for adoption is hereby dispensed with, the Court being satisfied by said petition and affidavit that the petitioner cannot with reasonable diligence ascertain a place or places where the said would probably receive the matter transmitted through the post office.) [Applicable to orders of the Family Court]: 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 LAW GUARDIAN UPON THE APPELLANT, WHICHEVER IS EARLIEST. ENTER ________________________________________ J.F.C. Date: 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.USCourtForms.com