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Petition For Registration Of Foreign Adoption Order (And Name Change) Form. This is a New York form and can be use in Adoption Statewide.
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Tags: Petition For Registration Of Foreign Adoption Order (And Name Change), 28, New York Statewide, Adoption
DRL §111-c
Adoption Form 28
Petition for Registration of Foreign
Adoption Order
9/2008
FAMILY COURT OF THE STATE OF NEW YORK
COUNTY OF
...........................................................................
In the Matter of Adoption of
A Child Whose First Name Is
Docket No.
PETITION FOR
REGISTRATION OF A
FOREIGN ADOPTION ORDER
(AND NAME CHANGE)
.....................................................................................
The Petitioner(s) respectfully allege(s) to this Court that :
1. ( I am)(We are) the Qadoptive parent(s) Qguardian Qguardian ad litem
of [child’s name]:
, who was born on [date of birth]:
in [country]:
.
The child was adopted in [country]:
on [date]:
(I am) (We are) submitting this petition to register the attached Order of Adoption
and [delete if inapplicable]: to change the child’s name to [specify]:
2. The adoptive parent(s) and the child reside at:[specify address(es)]:1
Child
Adoptive Parent(s)
Full Address
3. The child was granted an IR-3 immigrant visa by the United States Citizenship
and Immigration Services on [specify date]:
4. The name by which the adoptive child is to be known is [specify]:
WHEREFORE, the Petitioner(s) request(s) an order registering the attached Order
of Adoption, [delete if inapplicable] changing the child’s name, and such other and
further relief as the Court deems just and proper.
1
Unless the Court has ordered the address to be confidential on the ground that disclosure would pose an
unreasonable health or safety risk. If so, so indicate and simply list the STATE of residence. See Family Court Act
§154-b; Form 21 (available at www.nycourts.gov).
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Adoption Form 28
Dated:
,
Page 2
.
______________________________________/_______________________________
Adoptive Parent: typed or printed name/ signature
______________________________________/_____________________
Adoptive Parent: typed or printed name / signature
_________________________________________________/__________
QGuardian QGuardian ad Litem : typed or printed name / signature
_____________________/_______________________________
Attorney , if any: typed or printed name/ signature
____________________________________________________
Attorney’s Address and Telephone Number
VERIFICATION
STATE OF NEW YORK )
:ss.:
COUNTY OF
)
being duly sworn, says that (he)(she) (they)(is)(are) the Petitioner(s) in the above-named
proceeding and that the foregoing petition is true to (his)(her)(their) own knowledge,
except as to matters where in stated to be alleged on information and belief and as to
those matters (he)(she) (they) believe(s) it to be true.
______________________________________/_______________________________
Adoptive Parent: typed or printed name/ signature
______________________________________/_____________________
Adoptive Parent: typed or printed name / signature
_________________________________________________/__________
QGuardian QGuardian ad Litem : typed or printed name / signature
Sworn to before me this
day of ,
.
__________________________
(Deputy)Clerk of the Court
Notary Public
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