D.R.L. § 114 Form 16-B (Order for Certified Copy of Adoption Order - After sealing of records) (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 , PRESENT Hon. Judge ______________________________________ In the Matter of the Adoption of A Minor of the Age of (Docket Docket No. ) ORDER ON APPLICATION FOR CERTIFIED COPY OF ADOPTION ORDER (After sealing of records) years _____________________________________ UPON reading and filing the application of and duly verified the day of , , requesting this Court to issue an order authorizing the Clerk of the Court of the County of to prepare, certify and deliver to the applicant(s) a copy of the original order of adoption granted herein; and the Court being satisfied that there is good and proper cause for granting such request; and upon all of the proceedings had herein; it is [check applicable box]: G ORDERED that the application is GRANTED and the Clerk of the Court of the County of is directed to prepare, certify and deliver to the applicant(s) a copy of the original order of adoption granted herein. OR G ORDERED that the application is DENIED. [Applicable to Family Court Orders]: 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. Enter __________________________________ Judge ofof the Family Court / Surrogate Judge the Family Court/Surrogate Dated: 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