Adoptees Siblings Affidavit And Petition To Appoint A Confidential Intermediary {WYCAI-3}

WYCAI-3 (REV. 1/27/11) STATE OF WYOMING ) ) COUNTY OF ________________________) IN THE MATTER OF THE ADOPTION OF IN THE DISTRICT COURT SS _______________JUDICIAL DISTRICT CASE # __________________________ ADOPTEE'S SIBLING'S AFFIDAVIT AND PETITION TO APPOINT A CONFIDENTIAL INTERMEDIARY, PURSUANT TO W.S. 1-22-203(b) ) ) ) ) ) _______________________________________) _____________________________________________, being first duly sworn, on oath, petitions and says: (petitioner's name) I was born on __________________________________________and am 18 years of age or older. (date of birth) My current telephone numbers are: (home)_______________________(work)______________________ (cell) ___________________________. E-mail address________________________________________ Mailing address________________________________________________________________________. My birth brother/sister was born on ______________in__________________________________, (date of birth) (city/county) is 18 years of age or older, and was adopted on ______________________ in _______________________. (date, if known) (city/county, if known) I know the following about my birth brother's/sister's adoptive family: ______________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ I am seeking my birth brother/sister because: ________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ I, therefore, petition this court and respectfully request that an order be entered appointing a confidential intermediary, pursuant to W.S. 1-22-203(b) and that the confidential intermediary be allowed to inspect and copy, at the petitioner's expense, the pertinent adoption files of the court, governmental agencies, adoption agencies and hospitals. DATED this ______________day of _____________________________________________, 20 _______. _____________________________________________ (Petitioner's signature) SUBSCRIBED AND SWORN to before me this __________ day of __________________, 20________. My commission expires: ___________________________________ _____________________________________________ NOTARY PUBLIC OR DEPUTY CLERK OF COURT American LegalNet, Inc. www.FormsWorkFlow.com