Petition To Obtain Original Unsealed Un-Redacted Birth Certificate {13-21907-360}

ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address): FOR COURT USE ONLY TELEPHONE NO.: EMAIL ADDRESS: ATTORNEY FOR (Name): STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME: FAX NO.: SUPERIOR COURT OF CALIFORNIA, COUNTY OF IN THE MATTER OF: PETITION TO OBTAIN ORIGINAL UNSEALED/UN-REDACTED BIRTH CERTIFICATE CASE NUMBER: To request a copy of original birth certificate, complete this form and attach a copy of a valid photo identification or driver license. 1. Petitioner's name and permanent residence address: ________________________________________________ ___________________________________________________________________________________________ 2. Adoptee's date of birth and current age: ___________________________________________________________________________________________ 3. Adoptee's place of birth (city and state): ___________________________________________________________________________________________ 4. Provide the following information: a) Name of adoptive parents: __________________________________________________________________ b) Place of adoption (county in California): _______________________________________________________ c) Date of adoption: _________________________________________________________________________ 5. I request permission to obtain a copy of original birth certificate of the named person for the following reasons: ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ __________________________________________________________________________ Attachment to 5 6. Relationship to adopted individual: ______________________________________________________________ Form 13-21907-360 Rev 08/18/16 PETITION TO OBTAIN ORIGINAL UNSEALED/UN-REDACTED BIRTH CERTIFICATE Health & Saf. Code §102705 Family Code §9200 American LegalNet, Inc. www.FormsWorkFlow.com Name of Case: Case Number: VERIFICATION I am the petitioner in the above matter. I have read the foregoing Petition and know the contents thereof. I declare that the same is true of my own knowledge, except as to those matters which are therein stated upon my information and belief, and as to those matters I believe them to be true. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct Executed on _________________________ at _____________________________________________________ _______________________________________ Print Name _____________________________________________ Signature Form 13-21907-360 Rev 08/18/16 PETITION TO OBTAIN ORIGINAL UNSEALED/UN-REDACTED BIRTH CERTIFICATE Health & Saf. Code §102705 Family Code §9200 American LegalNet, Inc. www.FormsWorkFlow.com