Waiver Of Notice Of Petition For Access To Sealed Adoption Records {27-D}

D.R.L. §114 Adoption Form 27-D (Adoption­Waiver of Notice of Petition for Access to Sealed Adoption Records) (9/2006) FAMILY COURT OF THE STATE OF NEW YORK COUNTY OF ........................................................................................... In the Matter of the Adoption of A Child Whose First Name is (Docket)(File) No. WAIVER OF NOTICE OF PETITION FOR ACCESS TO SEALED ADOPTION RECORDS ........................................................................................... 1. I am the [check applicable box]: G Adoptive Mother G Adoptive Father G Other [specify]: of the above-named child. I am 18 years of age or older. 2. I am waiving the service of Notice of Petition for Access to Sealed Adoption Records in this matter and am consenting to the release of sealed adoption records to [specify]: Dated:______________________ ________________________________ (Signature of Interested Party) _________________________________ (Print Name) STATE OF____________________) COUNTY OF_________________) SS: On the___________________ day of______________in the year_________, before me, the undersigned, personally appeared_________________________________, personally known to me or proved to me on the basis of satisfactory evidence to be the individual (s) whose name (s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their capacity (ies), and that by his/her/their signatures (s) on the instrument, the individual (s), or the person, upon behalf of which the individual (s) acted, executed the instrument. _____________________________________________________ Notary Public (Deputy ) Clerk of Court _____________________________________ Signature of Attorney, if any _____________________________________ Attorney's Name (print or type) _____________________________________ _____________________________________ Attorney's Address and Telephone Number American LegalNet, Inc. www.FormsWorkflow.com Adoption Form 27-B Page 2 American LegalNet, Inc. www.FormsWorkflow.com