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Affidavit For Access To Adoption Record - Minnesota

Affidavit For Access To Adoption Record Form. This is a Minnesota form and can be used in Juvenile District Court Hennepin Local County .
 Fillable pdf Last Modified 1/31/2014
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STATE OF MINNESOTA COUNTY OF HENNEPIN DISTRICT COURT - JUVENILE DIVISION FOURTH JUDICIAL DISTRICT AFFIDAVIT AND ORDER FOR ADOPTION INFORMATION Name of Affiant (Completed forms may be faxed to (612) 317-6117 Attn: Records OR sent to Juvenile Justice Center - Records, 590 Park Ave, Minneapolis MN 55415) (person completing form): Current Street Address: Street Apt. City State Zip Code Phone Number of Affiant: (Home) ___________________________ (Cell) ____________________________ Name of Adopted Person: _______________________________ A/K/A: _____________________________ Adopted Person's Date of Birth: ___________________ Approximate Date of Adoption: _________________ Name of Adoptive Parent(s): ________________________________________________________________ Adoption Court File # (if known): ___________________ Your Relationship to adopted person: ____________ Affiant, being duly sworn, affirms that the identifying information as stated-above is true and accurate. Affiant further affirms that an Order of the Court is requested for the purpose of the affiant obtaining: A certified copy of an adoption decree. # of copies requested ________. The fee is $16.00 per copy payable to district court. Other document: [Must Specify] ____________________________________________ Which is information required for the following purpose: Social Security Passport Birth Certificate Personal Reasons (provide explanation): ___________________________ ____________________________________________________________ Other (provide explanation): _____________________________________ ____________________________________________________________ Dated: Affiant's Signature Subscribed and sworn to before me on this: _____ day of , 20 Notary Public / Deputy ORDER Based upon the foregoing Affidavit and consistent with Minnesota law, the request is denied. the Clerk of the above-named Court is authorized and directed to deliver to said affiant Dated: Judge of District Court -- Juvenile Division FOR OFFICE USE ONLY: ID Checked Mail out document(s) Fee is due Call for pick-up Put in access basket on American LegalNet, Inc. www.FormsWorkFlow.com Fee is attached Rev. 7/9/13 www.mncourts.gov/district/4
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