ONTARIO
Court File Number
(Name of Court)
Form 34G.1: Affidavit of Society
at
Employee for Adoption of a
Court office address
Crown Ward, sworn/affirmed
Applicant(s)
(The first letter of the applicant’s surname may be used)
Full legal name & address for service — street & number, municipality,
Lawyer’s name & address — street & number, municipality, postal
postal code, telephone & fax numbers and e-mail address (if any).
code, telephone & fax numbers and e-mail address (if any).
Respondent(s)
(If there is a respondent, the first letter of the respondent’s surname may be used)
Full legal name & address for service — street & number, municipality,
Lawyer’s name & address — street & number, municipality, postal
postal code, telephone & fax numbers and e-mail address (if any).
code, telephone & fax numbers and e-mail address (if any).
My name is
(full legal name)
I live in
(municipality & province)
and I swear/affirm that the following is true:
1.
The name of the child being placed for adoption is:
(Give full legal name, date of birth, sex and birth registration number if known of
person to be adopted. You may use an initial for the surname.)
Full legal name
Date of birth
Sex
Birth registration number
2.
I am an employee of
(full legal name of children’s aid society)
authorized to place the child for adoption.
3.
The child was made a Crown Ward by order of Justice
(name of judge)
On
. A copy of the Crown Wardship order and proof of service of the order are
(date)
attached to this affidavit.
4.
I have made reasonable inquiries about the existence of any outstanding orders of access to the child. To the best of my
knowledge,
there is no outstanding order.
A copy of the order ending access to the child made under s. 58 of the Child and Family Services Act made by Justice
on
(name of judge)
(date of order)
and proof of service of the order are attached to this affidavit.
Put a line through any space left on this page
FLR-34G-1-E (2011/08)