IN THE COURT OF COMMON PLEAS OF CHESTER COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION IN RE: {use initials only} Case Number: ___________________________ ORDER TO IMPOUND RECORDS AND NOW, this _________ day of _____ _______________, 20__, upon Motion of _____________________, Es quire, Attorney for Petitioners, it is hereby ORDERED and DECREED that any and all records k ept in the files of this Court relating to the above-captioned matter, including without limitation, the petition filed on or about [DATE PETITION FILED] pursuant to the Pennsylv Conception Birth Registrations' procedure and ania Department of H ealth's "Assisted all related papers and writ ings, be impounded and withheld from inspection by any one other than attorneys for parties to the proceedings, except upon an order of court granted upon cause shown. BY THE COURT: ______________________________________ J. American LegalNet, Inc. www.FormsWorkFlow.com