D.R.L. §114 Adoption Form 27-E (Adoption­Order on Petition for Access to Sealed Adoption 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 Child Whose First Name is Docket No. ORDER ON PETITION FOR ACCESS TO SEALED ADOPTION RECORDS ........................................................................................... The petition for access to sealed adoption records of the above-named child having been filed in this Court, and notice having been given to necessary parties, NOW, and upon all the papers and proceedings herein, it is hereby [check applicable box(es)]: G ORDERED that the Petition is GRANTED and that [specify]: to sealed adoption records on the following grounds: G To obtain medical information [specify]: G Other good cause [specify]: G [Applicable to petitions brought by Native-American adults 18 and older]: to obtain information on tribal affiliation [specify]: OR G ORDERED that the Petition is DENIED for the following reason(s) [specify]: shall be given access AND IT IS FURTHER ORDERED that [specify; delete if inapplicable]: ENTER ______________________________ G Judge of the Family Court G Surrogate Dated: , . American LegalNet, Inc. www.FormsWorkFlow.com Adoption Form 27-E Page 2 [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. 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