WYCAI-6 (REV. 1/27/11) STATE OF WYOMING ) ) COUNTY OF ________________________) IN THE MATTER OF THE ADOPTION OF ) ) ) ) ) ______________________________________ ) IN THE DISTRICT COURT _________ JUDICIAL DISTRICT CASE # ________________ ORDER APPOINTING CONFIDENTIAL INTERMEDIARY The court having reviewed the affidavit and petition to appoint a confidential intermediary, pursuant to W.S. 1-22-203(b), IT IS HEREBY ORDERED THAT ___________________________________ be appointed as the confidential intermediary of this case and pursuant to W.S. 1-22203(a)(i), the confidential intermediary shall have the right to inspect all pertinent confidential relinquishment and adoption records of the court, governmental agencies, adoption agencies and hospitals within the state of Wyoming and any other state that will so allow. The confidential intermediary shall have the right to inspect all records relevant to this adoption, including but not limited to birth, marriage, divorce and death records, without further order of the court. IT IS ALSO HEREBY ORDERED THAT in respect to hospital records, the confidential intermediary's interest in access to such hospital records outweighs the privacy interest of persons to whom such records relate, and, for good cause shown, the notification provisions of Wyoming Statutes 35-2-610(b) should be and are hereby waived. IT IS ALSO HEREBY ORDERED THAT the above-named confidential intermediary shall, pursuant to W.S. 1-22-203(d)(i), file with this court any written consent for contact which has been obtained from any party involved in this case. This filing shall take place prior to any contact between the parties. FURTHERMORE, IT IS HEREBY ORDERED THAT the above-named confidential intermediary shall, pursuant to W.S. 1-22-203(d)(ii), return to the court all relinquishment and adoption records and all other information obtained. Photocopying of records is authorized. DATED this _____ day of ___________________, 20____. __________________________________________ DISTRICT JUDGE American LegalNet, Inc. www.FormsWorkFlow.com