D.R.L. § 114
Form 16-B
(Order for Certified Copy of
Adoption Order - After sealing
of records)
(9/2006)
At a term of the Surrogate’s Court of the State of New York,
held in and for the County of ________________________,
at ___________________, New York, on_________, ____.
PRESENT
Hon.______________________
Judge
______________________________________
In the Matter of the Adoption of
(Docket) (File) No.
______________________
______________________________________
ORDER ON
A Minor of the Age of___years
APPLICATION FOR
CERTIFIED COPY OF
ADOPTION ORDER
_____________________________________
(After sealing of records)
UPON reading and filing the application of__________________________________________
and _________________duly verified the day of __________ ,_____, requesting this Court to issue an
order authorizing the Clerk of the________________Court of the County of ____________to prepare,
certify and deliver to the applicant(s) a copy of the original order of adoption granted herein; and the
Court being satisfied that there is good and proper cause for granting such request; and upon all of the
proceedings had herein; it is [check applicable box]:
ORDERED that the application is GRANTED and the Clerk of the ___________Court of the
County of ________________is directed to prepare, certify and deliver to the applicant(s) a copy of the
original order of adoption granted herein.
OR
ORDERED that the application is DENIED.
PURSUANT TO SECTION 1113 OF THE FAMILY COURT ACT, AN APPEAL FROM
THIS ORDER MUST BE TAKEN WITHIN 30 DAYS OF RECEIPT OF THE ORDER BY
APPELLANT IN COURT, 35 DAYS FROM THE DATE OF MAILING OF THE ORDER TO
APPELLANT BY THE CLERK OF COURT, OR 30 DAYS AFTER SERVICE BY A PARTY
OR THE LAW GUARDIAN UPON THE APPELLANT, WHICHEVER IS EARLIEST.
Enter
__________________________________
Judge of the Family Court/Surrogate
Dated:________,____.
Check applicable box:
Order mailed on [specify date(s) and to whom mailed]:________________________________
Order received in court on [specify date (s) and to whom given]:________________________
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