New York Codes, Rules and Regulations › Title 22 - JUDICIARY › Subtitle D - Forms › Chapter VII - Surrogate's Court Forms › Subchapter B - Adoption Forms Of The Surrogate's Court › Adoption Forms › Form 13-B - Order of adoption (private-placement)

Current through Register Vol. 46, No. 28, July
					 10, 2024
D.R.L. §§ 111, 112(b), 113, 114
						Form 13-B
(Order of Adoption
Private-Placement)
12/97
At a term of the Surrogate's Court of
						the
State of New York, held in and for
						the
County of ,
at New York
on, 19.
PRESENT:
Hon.
Judge
________
In the Matter of the Adoption of
						(Docket)(File) No.
A Child Whose First Name Is
ORDER OF
ADOPTION
(Private-Placement)
________
The Petition of (and
), verified the day of, 19, having been
						duly presented to this Court, together with an agreement on the part of the
						petitioning adoptive parent(s) to adopt and treat as (his) (her) (their) own
						lawful child and whose birth day is, 19, and who was born at as set forth in
						the petition for adoption herein, said petition having been attached thereto
						and made a part thereof a document setting forth all available information
						comprising the adoptive child's medical history; together with the affidavit(s)
						of
and the consent(s) of
;
AND, although (his)(her)(their) consent(s)
						(is) (are) not required, the Court having given notice of the proposed adoption
						to
[recite facts relative thereto]
Form 13-B Page 2
AND the aforesaid petitioning adoptive
						parents and the adoptive child and all other persons whose consents are
						required as aforesaid having personally appeared before this Court for
						examination, except
;
AND an investigation having been ordered
						and made and the written report of such investigation having been filed with
						the Court, as required by the Domestic Relations Law;
(AND the Court having (shortened)
						(dispensed with) the six-month waiting period between its receiving the
						petition to adopt and this order of adoption, pursuant to section
						116 of
						the Domestic Relations Law, because
;)
AND the adoptive child having resided with
						the petitioning adoptive parent(s) since (and the judge having dispensed with
						the six-month period of residency with the adoptive parent(s), pursuant to
						sections
						112 and
						116 of
						the Domestic Relations Law because
(iv), CPLR 315 (Order of Publication412 of
						the Social Services Law, (AND there being available to this Court findings of a
						court inquiry made within the preceding twelve months, of the statewide central
						register of child abuse and maltreatment that the (child) (adoptive parent(s))
						(is)(are) (not) a subject of or another person named in an indicated report
						filed with such register as such terms are defined in section
						412 of the
						Social Services Law) and the Court having given due consideration to any
						information contained therein;
Form 13-B Page 3
AND this Court being satisfied that the
						best interests of the adoptive child will be promoted by the adoption and that
						there is no reasonable objection to the proposed change of the name of the
						adoptive child;
NOW, on motion of
Attorney for the petitioners) herein, and
						upon all the papers and proceedings herein, it is
ORDERED that the petition of (and
) for the adoption of
a person born on, 19, at ,
be and the same hereby is allowed and
						approved; and it is further
ORDERED that the said adoptive child shall
						henceforth be regarded and treated in all respects as the lawful child of the
						said adoptive parent(s); and it is further
ORDERED that the name of the said adoptive
						child be and the same hereby is changed to and that
the said adoptive child shall hereafter be
						known by that name; and it is further
(ORDERED that the Clerk prepare, certify
						and deliver to
a copy of this order; and it is
						further)
ORDERED that the child's medical history,
						heritage of the parents, which shall include nationality, ethnic background and
						race; education, which shall be the number of years of school completed by the
						parents at the time of the birth of the adoptive child; general physical
						appearance of the parents at the time of the birth of the adoptive child,
						including height, weight, color of hair, eyes, skin; occupation of the parents
						at the time of birth of the adoptive child; health and medical history of the
						parents at the time of birth of the adoptive child, including all available
						information setting forth conditions or diseases believed to be hereditary, any
						drugs or medication taken during pregnancy by the mother; and other information
						which may be a factor influencing the child's present or future well-being,
						talents, hobbies and special interests of the parents as contained in the
						petition shall be furnished to the adoptive parents; and it is
Form 13-B Page 4
ORDERED that this order, together with all
						other papers pertaining to the adoption, shall be filed and kept as provided in
						the Domestic Relations Law and shall not be subject to access or inspections
						except as provided in said Law.
ENTER
______________
Surrogate
Dated:, 19.