Declaration And Order To Unseal Unredacted Original Birth Certificate (Packet HS102705) {FL-094b}

Name, Address of Petitioner or Attorney Telephone No. Petitioner SUPERIOR COURT OF CALIFORNIA, COUNTY OF STANISLAUS In the Matter of the Petition of: DECLARATION AND ORDER TO UNSEAL UNREDACTED ORIGINAL BIRTH CERTIFICATE (California Health and Safety Code 102705) CASE NUMBER: I,___________________________,declare as follows: I am the petitioner in the above-entitled matter. I was born on________________________ (date), in_____________________________ (city), _______________ County, State of California. I was adopted by _______________________________. After reviewing copies of my birth records, I feel these records are not sufficient. I need the original birth certificate because: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________. Enclosed is the VS-111 and a $20 check made payable to CDPH Vital Records. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date:________________ _____________________________ Type or Print Name _____________________________ Signature ORDER IT IS SO ORDERED that the Office of Vital Records unseal the original unredacted birth certificate on which the child's birth parents are stated and forward an intact certified copy no later than two months from the date of this order to: Petitioner:____________________________ Address:_____________________________ City, State & Zip:______________________ Date:________ ______________________________________ JUDGE OF THE SUPERIOR COURT Form Number: FL-094(b) Effective Date: 6/25/13 DECLARATION AND ORDER TO UNSEAL UNREDACTED ORIGINAL BIRTH CERTIFICATE HS § 102705 American LegalNet, Inc. www.FormsWorkFlow.com