D.R.L. § 116 Adoption Form 7 (Adoption--Report of InvestigationPrivate-Placement) 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)(File) No. REPORT OF INVESTIGATION (Private-Placement) TO THE COURT OF THE COUNTY OF ; Pursuant to the order for investigation dated the day of from the Honorable Judge of the Court, I, , have investigated the allegations set forth in the petition herein and any statements contained in the affidavits required by the Domestic Relations Law. On the basis of such investigation, I respectfully submit the following report: 1. The marital status, family members and history, religious affiliation, if any, of the adoptive parent(s) and adoptive child are: ; 2. The physical and mental health of the adoptive parent(s) and adoptive child are: ; 3. The adoptive parent(s) have an income of and own the following property: 4. The following fees, compensation or other remuneration have been paid or agreed upon with respect to the placement of the child for adoption: To the birth parent: To the attorney for the birth parent: American LegalNet, Inc. www.FormsWorkflow.com Form 7 page 2 To agency: To attorney for agency: To attorney for adoptive parent: Other (specify): 5. The adoptive parent(s) (has)(have) not been (a) respondent(s) in any proceeding involving children alleged to be neglected, abandoned, abused, delinquent or in need of supervision except: ; 6. The following other facts relations to the familial, social, emotional and financial circumstances or the adoptive parent(s) may be relevant to a determination of adoption: Dated: ,. ______________________________ Investigator ___________________________________ Petitioner ___________________________________ Print or type name ___________________________________ Signature of Attorney, if any ___________________________________ Attorney's Name (Print or Type) ___________________________________ ___________________________________ ___________________________________ Attorney's Address and Telephone Number American LegalNet, Inc. www.FormsWorkflow.com