Petition For Registration Of Foreign Adoption Order (And Name Change) {28}

DRL §111-c Adoption Form 28 Petition for Registration of Foreign Adoption Order 9/2008 FAMILY COURT OF THE STATE OF NEW YORK COUNTY OF ........................................................................... In the Matter of Adoption of A Child Whose First Name Is Docket No. PETITION FOR REGISTRATION OF A FOREIGN ADOPTION ORDER (AND NAME CHANGE) ..................................................................................... The Petitioner(s) respectfully allege(s) to this Court that : 1. ( I am)(We are) the Qadoptive parent(s) Qguardian Qguardian ad litem of [child's name]: , who was born on [date of birth]: in [country]: . The child was adopted in [country]: on [date]: (I am) (We are) submitting this petition to register the attached Order of Adoption and [delete if inapplicable]: to change the child's name to [specify]: 2. The adoptive parent(s) and the child reside at:[specify address(es)]:1 Child Adoptive Parent(s) Full Address 3. The child was granted an IR-3 immigrant visa by the United States Citizenship and Immigration Services on [specify date]: 4. The name by which the adoptive child is to be known is [specify]: WHEREFORE, the Petitioner(s) request(s) an order registering the attached Order of Adoption, [delete if inapplicable] changing the child's name, and such other and further relief as the Court deems just and proper. Unless the Court has ordered the address to be confidential on the ground that disclosure would pose an unreasonable health or safety risk. If so, so indicate and simply list the STATE of residence. See Family Court Act §154-b; Form 21 (available at www.nycourts.gov). 1 American LegalNet, Inc. www.FormsWorkflow.com Adoption Form 28 Page 2 Dated: , . ______________________________________/_______________________________ Adoptive Parent: typed or printed name/ signature ______________________________________/_____________________ Adoptive Parent: typed or printed name / signature _________________________________________________/__________ QGuardian QGuardian ad Litem : typed or printed name / signature _____________________/_______________________________ Attorney , if any: typed or printed name/ signature ____________________________________________________ Attorney's Address and Telephone Number VERIFICATION STATE OF NEW YORK ) :ss.: COUNTY OF ) being duly sworn, says that (he)(she) (they)(is)(are) the Petitioner(s) in the above-named proceeding and that the foregoing petition is true to (his)(her)(their) own knowledge, except as to matters where in stated to be alleged on information and belief and as to those matters (he)(she) (they) believe(s) it to be true. ______________________________________/_______________________________ Adoptive Parent: typed or printed name/ signature ______________________________________/_____________________ Adoptive Parent: typed or printed name / signature _________________________________________________/__________ QGuardian QGuardian ad Litem : typed or printed name / signature Sworn to before me this day of , . __________________________ (Deputy)Clerk of the Court Notary Public American LegalNet, Inc. www.FormsWorkflow.com