V I R G I N I A: FAIRFAX CIRCUIT COURT IN RE: ADOPTION OF MINOR CHILD AD-_______-________________ _______________________________ AFFIDAVIT FOR SERVICE BY PUBLICATION , Petitioner herein, seeking Comes now , the natural parent by ORDER OF service on PUBLICATION, and who under oath deposes and states under oath that the Natural Parent in this cause Is a non-resident individual, other than a non-resident individual fiduciary who has appointed a statutory agent; OR Cannot be found, and that diligence has been used without effect to ascertain the location of the party to be served; OR Cannot be served with court process, and that a return has been filed by the Sheriff which shows that the process has been in his or her hands for twenty-one (21) days and the Sheriff has been unable to make service; OR OTHER: __________________________________________________________ __________________________________________________________________ __________________________________________________________________ and the last known mailing address of Natural Father/Mother is as follows: Name: _________________________________________________ Address:________________________________________________ OTHER INFORMATION: __________________________________________ __________________________________________________________________ ____________________________ Signature of Petitioner ____________________________ Counsel for Petitioner TO BE COMPLETED BY A NOTARY PUBLIC/ OR DEPUTY CLERK Commonwealth/State of: Subscribed and sworn to before me this County of : _____________________________ day of , . My Commission Expires: Notary Public/Deputy Clerk American LegalNet, Inc. www.FormsWorkflow.com CCR-A-10 Updated July 1, 2007 V I R G I N I A: FAIRFAX CIRCUIT COURT IN RE: ADOPTION OF MINOR CHILD AD- ________-____________ _______________________________ ORDER OF PUBLICATION The reason for this cause is to obtain an adoption An affidavit having been made and filed showing that the Natural Parent in the above-entitled cause Is a non-resident individual, other than a non-resident individual fiduciary who has appointed a statutory agent; OR Cannot be found, and that diligence has been used without effect to ascertain the location of the party to be served; OR Cannot be served with court process, and that a return has been filed by the Sheriff which shows that the process has been in his or her hands for twenty-one (21) days and the Sheriff has been unable to make service; OR OTHER: _________________________________________________________ and last known mailing address of Natural Father/Mother is as follows: Name: Address: ______________________________________ TO BE COMPLETED BY CLERK’S OFFICE Upon consideration, this Order of Publication is granted, and It is ORDERED that the above named Natural Parent shall appear here on or before day of , after proper publication of this Order, to protect his/her interest in this cause. Entered: TESTE: JOHN T. FREY, CLERK BY: ________________________ DEPUTY CLERK ________________________________ Signature of Petitioner or Counsel for Petitioner ____________________________ Print Name __________________________ Address _____ _______ _______________________________________________ _______________________________________________ Phone Number CCR-A-10 Updated July 1, 2007 American LegalNet, Inc. www.FormsWorkflow.com