Affidavit Of Adoption
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3ONTARIO
Court File Number
(Name of Court)
Form 34G: Affidavit of Adoption
at
Licensee or Society Employee,
Court office address
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. If this person is a Crown ward or was placed for adoption by a licensee or children’s aid society, you may use an
initial for the surname.)
Full legal name
Date of birth
Sex
Birth registration number
2.
a person licensed under Part IX of the Child and Family Services Act to place the child for adoption.
I am
an employee of
(full legal name of children’s aid society)
authorized to place the child for adoption.
an employee of
(full legal name of adoption agency)
which is licensed under Part IX of the Child and Family Services Act to place the child for adoption.
3.
I have made reasonable inquiries about the existence of any outstanding orders of custody of or access to the child. To the
best of my knowledge,
there is no outstanding order.
the outstanding order(s) is/are as follows:
(For each order, give the name of the court, date of order, name of judge,
court file number and full legal name(s) of the person(s) given custody or access under the order.)
Put a line through any space left on this page
FLR-34G-E (2005/09)
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