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Affidavit (Change Of Circumstance Since Certification As Qualified Adoptive Parent) (Private Placement) 1-Ca - New York
| Affidavit (Change Of Circumstance Since Certification As Qualified Adoptive Parent) (Private Placement) Form. This is a New York form and can be used in Adoption Statewide . |
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D.R.L. §115, 115-d Form 1-Ca (Affidavit - Change of Circumstance) Private-Placement 9/99 COURT OF THE STATE OF NEW YORK COUNTY OF In the Matter of Adoption of A Child Whose First Name Is (Docket)(File) No. AFFIDAVIT (Change of circumstance since certification as qualified adoptive parent) (Private-Placement) STATE OF NEW YORK COUNTY OF ) :ss.. ) , being duly sworn depose(s) and say(s): 1. Deponent(s) (was)(were) certified as (a) qualified adoptive parent(s) by order of the County of , dated , ; 2. The following change(s) in circumstance relevant and material to such certification (has)(have) taken place since that date: court Date: ___________________________________ Petitioner ___________________________________ Print or type name ___________________________________ Signature of Attorney, if any ___________________________________ Attorney's Name (Print or Type) ___________________________________ ___________________________________ ___________________________________ Attorney's Address and Telephone Number Sworn to before me this day of , . 2001 © American LegalNet, Inc. Form 1-Ca page 2 2001 © American LegalNet, Inc.
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