Adoption Form 27-C - Affidavit Of Service Of Petition For Access To Sealed - Surrogate'S Court Of The State Of New York

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D.R.L. §114
Adoption Form 27-C
(Adoption– Affidavit of Service
[This form must be filed at least two days
of Petition for Access to Sealed
before the return date in Court. It must state
Adoption Records)
the date, time and place of service ]
(9/2006)
SURROGATE’S COURT OF THE STATE OF NEW YORK
COUNTY OF _____________________________
...........................................................................................
In the Matter of the Adoption of
(Docket)(File) No.
A Child Whose First Name is
_____________________
AFFIDAVIT OF SERVICE
_____________________________________________
OF PETITION FOR
ACCESS TO SEALED
ADOPTION RECORDS
...........................................................................................
STATE OF__________________________)
COUNTY OF _______________________) SS:
I, [name]:_________________________of [state residence or business address]:_____
__________having been duly sworn, deposes and states the following under penalties of perjury:
1. I am over the age of eighteen years.
2. I personally served the Notice of Petition for Access to Sealed Adoption Records on
each person named below, each of whom I knew to be the person mentioned and described in the
Notice, by delivering to and leaving with each of them personally a true copy of the Notice :
Name: __________________________________________________________
Date and Time served: _____________________________________________
Place served: _____________________________________________________
Physical description of person served: Sex:_________Skin color:__________Hair color:______
Approximate age:________Weight:______Height:_____
Name: __________________________________________________________
Date and Time served: _____________________________________________
Place served: _____________________________________________________
Physical description of person served: Sex:_________Skin color:__________Hair color:______
Approximate age:_______Weight:_______Height:_____
3. None of the persons named above is in the military service as defined by the Act of
Congress known as the “Soldiers’ and Sailors’ Civil Relief Act of 1940" and the New York
“Soldiers’ and Sailors’ Civil Relief Act.”
Dated ____________,______.
______________________________________
Affiant
______________________________________
Print or Type Name
Sworn to before me this_____
day of _________ ,____.
(Deputy) Clerk of the Court
Notary Public

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