Petition For Birth Record Information {JUV-236}

SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN DIEGO FOR COURT USE ONLY CENTRAL DIVISION, JUVENILE COURT, 2851 MEADOW LARK DR., SAN DIEGO, CA 92123 NORTH COUNTY DIVISION, 325 S. MELROSE DR., SUITE 130, VISTA, CA 92081 IN THE MATTER OF PETITION FOR BIRTH RECORD INFORMATION CASE NUMBER To request birth record information and/or copies of birth records, please complete this form and attach a copy of a valid photo identification or driver license. 1. Petitioner's name and permanent residence address (if representing another person, organization, or agency, provide names and addresses): __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ Petitioner's date of birth and current age (skip this if representing another person, organization, or agency): __________________________________________________________________________________________ Petitioner's place of birth (city and state) (skip this if representing another person, organization, or agency): __________________________________________________________________________________________ If petitioner is the adoptee, please provide: Names of adoptive parents 2. 3. 4. ___________________________________________________ ___________________________________________________ Date of adoption ___________________________________________________ Place of adoption (county in California) ___________________________________________________ Attach copy of adoption petition, adoption decree, etc., if available. If petitioner is not the adoptee (birth parent, adoptive parent, or other), please provide: Name of adoptee ___________________________________________________ Date of birth ___________________________________________________ Place of birth ___________________________________________________ Relationship of petitioner to adoptee ___________________________________________________ Names of adoptive parents ___________________________________________________ ___________________________________________________ Date of adoption ___________________________________________________ Place of adoption (county in California) ___________________________________________________ 5. Petitioner requests the following information and/or documents: SDSC JUV-236 (New 12/11) PETITION FOR BIRTH RECORD INFORMATION Health & Saf. Code § 102705 Fam Code §§ 8619, 9200 Page 1 of 3 American LegalNet, Inc. www.FormsWorkFlow.com 6. Please state in complete detail all reasons for your request that apply in your case. Attach additional pages if necessary. Also, attach all letters or documents from official sources (such as a physician) that would support your request. A. I am requesting an adoption decree, a court report of adoption, and/or an original birth certificate. The "good and compelling cause" required (Health & Saf. Code § 102705) to grant this request is as follows: Medical or health reasons (discuss in detail, especially if life-threatening): ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ Legal reasons: ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ Search for a missing person: ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ Other reasons: ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ B. I am requesting the name(s) and/or address(es) of birth parent(s). This information is "necessary to assist. . . in establishing a legal right" (as required by Health & Saf. Code § 102705), as follows: ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ I am requesting copies of documents pertaining to the degree of Indian blood and tribal enrollment and/or the certificate of degree of Indian blood, and one of the following is true (as required by Fam. Code § 8619): These documents are required by the Bureau of Indian Affairs to determine the adoptee's eligibility to receive services or benefits because of the adoptee's status as an Indian. I am the adoptee, and I am 18 years of age or older. D. I am requesting authorization to inspect a petition, relinquishment or consent, agreement, order, report to the court from an investigating agency, and/or a power of attorney or deposition filed in the office of the Clerk of the Court related to the adoption. I understand that I may be required to pay the expenses for preparing copies of these documents. The "exceptional circumstances" and "good cause approaching the necessitous" required (Fam. Code § 9200) to grant this request are as follows: ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ VERIFICATION C. SDSC