Adoption Form 28-A - Order Of Foreign Adoption And Name Change - New York Surrogate Court
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2D.R.L. §§111-c
Adoption Form 28-A
(Order of Foreign Adoption
and Name Change)
9/2008
At a term of the Surrogate Court of the
State of New York, held in and for the
County of ____________________ ,
at _________________New York
on ____________,____.
PRESENT:
Hon. _________________________
Judge
____________________________________
QDocket QFile No.
In the Matter of the Adoption of
A Child Whose First Name Is
____________________________________
ORDER OF FOREIGN
ADOPTION
(AND NAME CHANGE)
____________________________________
The Petition of ______________________________ (and___________________
______________), verified the ______day of _____________,_____, together with the Order of
Adoption of [specify country]:_________________________ , dated [specify]:______________,
having been presented to this Court,
This Court hereby finds and determines the following:
1. The names and states of residence of the adoptive parent(s) is/are [specify]:______________
_______________________________________________________.
2. The child [specify name]: ______________________________________________________
was reported to have been born on [specify date]:_________________________ in [country]:
______________________________________________________________________________
3. The child was adopted in [country]:_________________on [specify date]:________________
4. The child was granted an IR-3 immigrant visa by the United States Citizenship and
Immigration Services on [specify date]:______________________________________________
NOW, and upon all the papers and proceedings herein, it is
ORDERED that the petition of ______________________________(and_______
_____________ ) for the registration of the adoption of [child’s name]:
is GRANTED; and it is further
ORDERED that the Order of Adoption issued in [country]: __________________
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