Affidavit Of Adoption Of Applicant
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3ONTARIO
Court File Number
(Name of Court)
Form 34D: Affidavit of
Adoption of Applicant(s),
at
sworn/affirmed
Court office address
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).
Child
(Child’s full legal name. If this person is a Crown ward or was placed by a licensee or children’s aid society, you may use an initial for
the surname.)
Date of birth
Sex
Birth registration number
My/Our name is/are
(full legal name(s))
I/We live in
(municipality & province)
and I/we swear/affirm that the following is true:
1.
I am/We are the applicant(s) for the adoption of the child in this case and reside in Ontario.
My/Our birthdate(s) is/are:
2.
(For two persons, indicate which birthdate belongs to whom.)
The details of my/our background are as follows:
3.
(Give details of your health, education, employment, ability to support and care for
the child and any other relevant background material. If you need more space, you may add a page.)
Put a line through any blank space left on this page.
FLR-34D-E (2009/04)
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