reglab/statecodes huggingface dataset:
New York Codes, Rules and Regulations › Title 22 - JUDICIARY › Subtitle D - Forms › Chapter VII - Surrogate's Court Forms › Subchapter A - Forms Authorized By Section 207.52 › Surrogate's Forms › Form SG-5 - Affidavit and consent of proposed standby guardian pursuant to SCPA 1726(3)

Current through Register Vol. 46, No. 28, July
					 10, 2024
SURROGATE'S COURT OF THE STATE OF NEW
						YORK
COUNTY OF ________
________x AFFIDAVIT AND CONSENT
Proceeding for the Appointment OF PROPOSED
						STANDBY
of a Standby Guardian for GUARDIAN
						PURSUANT TO
SCPA 1726 (3)
________
An Infant.
________x File No. ________
STATE OF NEW YORK)
) ss.:
COUNTY OF ________)
________, being duly sworn, deposes and
						says:
1. I am a competent person over the age of
						eighteen years, and I submit this affidavit in support of the petition to have
						me appointed standby guardian of the [ ] person only, [ ] property only, or [ ]
						person and property of the above named infant. [Check one]
2. I have known the subject infant since
						________ by reason of the following [State relationship, if any]:
____________
____________
____________
____________
3. I reside at ____________
and the other resident members of my
						household are [Include all persons residing there and their respective
						ages]:
____________
____________
____________
____________
____________
____________
____________
____________
4. Except for minor treaffic offenses and
						adjudications as a youthful offender or juvenile delinquent:
(a) Have you ever been convicted of a
						crime [ ] yes [ ] no
(b) Have you ever forfeited bail or other
						collateral [ ] yes [ ] no
(c) Do you have criminal charges pending
						against you [ ] yes [ ] no
(d) Do you have a physician impairment or
						mental or medical condition that would interfere with your ability to perform
						the duties of guardian of the infant [ ] yes [ ] no
(e) Have you ever used controlled
						substances or narcotics or been addicted to alcohol [ ] yes [ ] no
[If you have answered "yes" to any of the
						questions set forth in (a) - (e), set forth details in space provided].
____________
____________
____________
5. I am willing and able to undertake the
						care, custody and control of the infant until the infant attains the age of
						eighteen or until the court determines otherwise.
6. Upon the petitioner's [ ] incapacity, [
						] death, [ ] or incapacity or death, or upon written consent, I agree to file
						all necessary documentation with the court within 90 days of the receipt of the
						determination of the incapacity, death certificate, or written consent.
________________
Signature of the Proposed Standby
						Guardian
Sworn to before me this
________ day of ________,
						19________
______________
Notary Public
Commission Expires:
(Affix Notary Stamp or
						Seal)
New York Codes, Rules and Regulations › Title 22 - JUDICIARY › Subtitle D - Forms › Chapter VII - Surrogate's Court Forms › Subchapter A - Forms Authorized By Section 207.52 › Surrogate's Forms › Form SG-6 - Consent of petition for standby guardian

Current through Register Vol. 46, No. 28, July
					 10, 2024
SURROGATE'S COURT OF THE STATE OF NEW
						YORK
COUNTY OF ________
________x CONSENT OF PETITIONER
Proceeding for the Appointment FOR STANDBY
						GUARDIAN
of a Standby Guardian for (Pursuant to
						SCPA 1726 (3) (e) (iii))
________
An Infant.
________x File No. ________
I ________, state that:
1. I am the petitioner in the proceeding
						for the appointment of a Standby Guardian of my minor child.
2. A decree was signed on ________
						appointing ________ standby guardian effective upon the execution of this
						consent.
3. Notwithstanding the request in the
						petition that the Standby Guardian's authority be effective upon my
						(incapacity) (death) (incapacity or death), [Delete inapplicable provision] I
						hereby consent to commencement of the Standby Guardian's authority upon (his)
						(her) receipt of this written consent executed in accordance with the
						provisions of Section
						1726 (3) (e)
						(iii) of the Surrogate's Court Procedure
						Act.
4. I am physically unable to sign this
						written consent and have directed
______________
Name of person other than Standby Guardian
						to sign on my behalf in my presence and in the presence of two witnesses whose
						signatures are set forth below [Delete if inapplicable]
Dated: ________
______________
Petitioner's Signature
______________
Signature of Person other than
						Petitioner
I declared that the person whose name
						appears above (signed this consent in my presence) (was physically unable to
						sign and asked another to sign this document, who did so in my presence). I
						further declare that I am at least eighteen years old and am not the person
						designated as standby guardian.
Dated: ________ Witness:
______________
Signature
______________
Print Name
______________
Address
________
Dated: ________ Witness:
______________
Signature
______________
Print Name
______________
Address
________
I
(Name of Standby Guardian) appointed or
						designated as such by ________
hereby acknowledge that I have received
						the foregoing consent on the following date ________.
______________
Signature
______________
Print Name
[Note: The Standby Guardian must file this
						written consent with the Court within 90 days of receipt of the written
						consent. Failure to file may result in the guardian's authority being rescinded
						by the Court.]
Name of Attorney: ____________ Tel. No.
						________
Address of Attorney: ____________
____________
New York Codes, Rules and Regulations › Title 22 - JUDICIARY › Subtitle D - Forms › Chapter VII - Surrogate's Court Forms › Subchapter A - Forms Authorized By Section 207.52 › Surrogate's Forms › Form SG-7 - Consent of infant over 14

Current through Register Vol. 46, No. 28, July
					 10, 2024
SURROGATE'S COURT OF THE STATE OF NEW
						YORK
COUNTY OF ________
________x
Proceeding for the Appointment of a
						Standby Guardian for CONSENT OF INFANT OVER 14
________
File No. ________
An Infant.
________x
I, the infant herein, being over 14 years
						of age, join in the foregoing petition and consent that ________ be appointed
						standby guardian of my
[ ] person only
[ ] property only
[ ] person and property
______________
(Signature)
______________
(Print Name)
STATE OF NEW YORK)
) ss.:
COUNTY OF ________)
On ________ 19 ________, before me
						personally came ________ to me known and known to me to be the person described
						in and who executed the foregoing instrument, and duly acknowledged to me that
						________he executed the same.
______________
Notary Public
Commission Expires:
(Affix Notary Stamp or Seal)
Name of Attorney: ____________ Tel. No.
						________
Address of Attorney: ____________
____________
New York Codes, Rules and Regulations › Title 22 - JUDICIARY › Subtitle D - Forms › Chapter VII - Surrogate's Court Forms › Subchapter A - Forms Authorized By Section 207.52 › Surrogate's Forms › Form SG-8 - Decree appointing a standby guardian

Current through Register Vol. 46, No. 28, July
					 10, 2024
SURROGATE'S COURT OF THE STATE OF NEW
						YORK
COUNTY OF ________
________x
Proceeding for the Appointment of a
						Standby Guardian for DECREE APPOINTING
A STANDBY GUARDIAN
________ (SCPA 1726(3))
An Infant. File No. ________
________x
A petition having been filed by ________,
						praying for the appointment of a Standby Guardian for the above named infant,
						and it appearing that the petitioner suffers from a progressively chronic or
						fatal illness; and that the interests of the infant will be promoted by the
						appointment of a Standby Guardian of the infant's person and/or property; and
						that ________ is in all respects competent to act as such Standby Guardian; it
						is hereby
ORDERED, ADJUDGED AND DECREED, that
						________ be and is hereby appointed Standby Guardian of the person and/or
						property of the infant, whose authority shall be effective upon the receipt by
						the standby guardian of
[ ] a determination of the petitioner's
						incapacity
[ ] a certificate of petitioner's
						death
[ ] a determination of petitioner's
						incapacity or certificate of petitioner's death, whichever occurs first.
The authority of the Standby Guardian
						shall also be effective upon the petitioner's written consent pursuant to
						Section
						1726
						(3)(e)(iii) of the Surrogate's Court
						Procedure Act; and it is further
ORDERED, ADJUDGED AND DECREED, that the
						Standby Guardian of the infant shall file a copy of a determination of
						incapacity or certificate of death or written consent by the petitioner with
						this court within 90 days of the date of receipt of same by the Standby
						Guardian or his or her authority may be rescinded by the court; and it is
						further
ORDERED, ADJUDGED AND DECREED, that
						letters of Guardianship shall be issued to the Standby Guardian upon his or her
						filing the Confirmation Affidavit of Standby Guardian, qualifying pursuant to
						SCPA Section 708, and complying with the provisions of SCPA Section 1708, if
						applicable.
______________
, Surrogate
Dated: ________,
						19________
New York Codes, Rules and Regulations › Title 22 - JUDICIARY › Subtitle D - Forms › Chapter VII - Surrogate's Court Forms › Subchapter A - Forms Authorized By Section 207.52 › Surrogate's Forms › Form SG-9 - Confirmation affidavit of standby guardian

Current through Register Vol. 46, No. 28, July
					 10, 2024
SURROGATE'S COURT OF THE STATE OF NEW
						YORK
COUNTY OF ________
________x
Proceeding for the Appointment of a
						Standby Guardian for CONFIRMATION AFFIDAVIT
OF STANDBY GUARDIAN
________
An Infant. File No. ________
________x
STATE OF NEW YORK)
) ss.:
COUNTY OF ________)
The undersigned, Standby Guardian, being
						duly sworn, says:
1. I was appointed standby guardian of the
						above named infant by this Court by decree dated ________
2. There has been [ ] no material change [
						] a material change in the circumstances of the infant since the filing of the
						petition. [If any material changes, so specify]
3. The petitioner has [ ] died [ ] been
						incapacitated [ ] made a written consent where by I am now entitled to receive
						letters of Guardianship.
4. I have never been named as a subject of
						an indicated report filed pursuant to Title 6 of Article 6 of the Social
						Services Law, or have been the subject of or the respondent in a child
						protective proceeding commenced under Article 10 of the Family Court Act, which
						proceeding resulted in an order finding that the child is an abused or
						neglected child, except: [Explain in detail].
____________
____________
____________
____________
5. OATH OF GUARDIAN: I am over eighteen
						years of age and a citizen of the United States, domiciled in the State of New
						York; that I will well, faithfully and honestly discharge the duties as
						guardian. I am acquainted with the estate of the infant and have read the
						statement contained in the petition filed with the Court as to the estimated
						value of same, and believe same to be correct. I am not ineligible to receive
						letters.
6. DESIGNATION OF CLERK FOR SERVICE OF
						PROCESS: I hereby designate the Clerk of the Surrogate's Court of ________
						County, and his or her successor in office, as a person on whom service of any
						process issuing from such Surrogate's Court may be made, in like manner and
						with like effect as if it were served personally upon me whenever I cannot be
						found and served within the State of New York after due diligence is
						used.
My domicile is: ____________
(Street/Number) (City, Village/Town)
						(State) (Zip)
______________
Signature of Proposed Guardian
STATE OF NEW YORK)
) ss.:
COUNTY OF ________)
On ________, 19 ________, before me
						personally appeared ________ to me known and known to to be the person
						described in and who executed the foregoing instrument, and duly acknowledged
						to me that ________ he executed the same.
______________
Notary Public
______________
Name of Attorney
Commission Expires: ________
(Affix Notary Stamp or Seal)
						Address
________
Telephone Number
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 1-Ca - Affidavit (change of circumstance since certification as qualified adoptive parent) (private-placement)

Current through Register Vol. 46, No. 28, July
					 10, 2024
D.R.L. §§ 115, 115-d Form
						1-Ca
(Affidavit - Change of
Circumstance)
Private-Placement
12/97
SURROGATE'S COURT OF THE STATE OF NEW
						YORK
COUNTY OF
________
In the Matter of the Adoption of
						(Docket)(File) No.
A Child Whose First Name is
AFFIDAVIT
(Change of
circumstance since
certification as qualified
adoptive parent)
(Private-Placement)
________
STATE OF NEW YORK)
:ss.:
COUNTY OF)
, being duly sworn depose(s) and
						say(s):
1. Deponent(s) (was)(were) certified as
						(a) qualified adoptive parent(s) by order of the Court, County of, dated, 19
						;
2. The following change(s) in circumstance
						relevant and material to such certification (has)(have) taken place since that
						date:
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, 19.
________
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 2-A - Agreement of adoption and consent (agency)

Current through Register Vol. 46, No. 28, July
					 10, 2024
D.R.L. §§ 111(1)(f), 112(2)(b),
						Form 2-A
113 (Agreement of Adoption
and Consent --Agency)
12/97
SURROGATE'S COURT OF THE STATE OF NEW
						YORK
COUNTY OF
________
In the Matter of the Adoption of (Docket)
						(File) No.
A Child Whose First Name Is
AGREEMENT OF
ADOPTION AND
CONSENT (Agency)
________
The undersigned petitioning adoptive
						parent(s) hereby agree(s) to adopt the above-named adoptive child and to treat
						said child in all respects as (his) (her) (their) own lawful child and to
						extend and assure to said child all the rights, benefits and privileges
						incident to such relationship, and to incur and fulfill all the
						responsibilities of (a) (parent) (parents) with respect to said child.
Dated:
/
_________________________
Adoptive Parent: typed or printed
						name/signature
/
_________________________
Adoptive Parent: typed or printed
						name/signature
/
_________________________
Adoptive child if over 18: typed or
						printed name/signature
/
_________________________
Attorney if any: typed or printed
						name/signature
_________________________
Attorney's Address and Telephone
						number
Form 2-A Page 2
The undersigned authorized agency hereby
						consents to the adoption of the above-named adoptive child by the petitioning
						adoptive parent(s).
Name of Authorized Agency: ________
By: ________
______________
Title
STATE OF NEW YORK)
ss:
COUNTY OF)
On this day of, 19,, the person who
						executed the foregoing instrument, personally came before me and acknowledged
						that (he)(she) executed the same.
______________
Notary Public
STATE OF NEW YORK)
ss:
COUNTY OF)
On this day of, 19,, the person who
						executed the foregoing instrument, personally came before me and acknowledged
						that (he)(she) executed the same.
______________
Notary Public
Form 2-A Page 3
STATE OF NEW YORK)
ss:
COUNTY OF)
On this day of, 19, before me personally
						came, to me known and who by me being duly sworn did depose and say:
That he/she resides at
County of State of :
that he/she is [specify position]:
of [specify authorized agency]:
(b) . The adoptive parent(s) (has)(have)
						(no) knowledge of any criminal record concerning themselves or any other adult
						residing in the household (except)
______________
Notary Public
State of New York)
ss:
County of)
On this day of, 19 ,
, proven to me by the oath of
an attorney admitted to practic in the
						State of New York, to be the person who executed the foregoing instrument,
						personally came before me and acknowledged that (he)(she) executed the
						same.
______________
Judge of the Court
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 2-B - Agreement of adoption (private-placement)

Current through Register Vol. 46, No. 28, July
					 10, 2024
D.R.L. §§ 111(1)(f), 115(4) Form
						2-B
(Agreement of Adoption
Private-Placement)
12/97
COURT OF THE STATE OF NEW YORK
COUNTY OF
________
In the Matter of the Adoption of (Docket)
						(File) No.
A Child whose First Name is
AGREEMENT OF
ADOPTION
(Private-Placement)
________
The undersigned petitioning adoptive
						parent(s) hereby agree(s) to adopt the above-named adoptive child and to treat
						said child in all respects as (his) (her) (their) own lawful child and to
						extend and assure to said child all the rights, benefits and privileges
						incident to such relationship, and to incur and fulfill all the
						responsibilities of (a) parent(s) with respect to said child.
Dated:
/
_________________________
Adoptive Parent: typed or printed
						name/signature
/
_________________________
Adoptive Parent: typed or printed
						name/signature
/
_________________________
Adoptive child if over 18: typed or
						printed name/signature
/
_________________________
Attorney if any: typed or printed
						name/signature
_________________________
Attorney's Address and Telephone
						number
Form 2-B page 2
STATE OF NEW YORK)
ss:
COUNTY)
On this day of, 19,, the person who
						executed the foregoing instrument, personally came before me and acknowledged
						that (he)(she) executed the same.
______________
Notary Public
STATE OF NEW YORK)
ss:
COUNTY)
On this day of, 19,, the person who
						executed the foregoing instrument, personally came before me and acknowledged
						that (he)(she) executed the same.
______________
Notary Public
STATE OF NEW YORK)
ss:
COUNTY)
On this day of, 19, proven to me by the
						oath of, an attorney admitted to practice in the State of New York, to be the
						person(s) who executed the foregoing instrument, personally came before me and
						acknowledged that (he)(she) executed the same.
________
Judge of the Court
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 2-C - Consent of child over 14 (agency)

Current through Register Vol. 46, No. 28, July
					 10, 2024
Sec. 111(1)(a) D.R.L. Adoption Form
						2-C
(Consent of Child-
Agency)
12/97
COURT OF THE STATE OF NEW YORK
COUNTY OF
________
In the Matter of the Adoption of (Docket)
						(File) No.
A Child Whose First Name Is
CONSENT OF CHILD
OVER 14
________
The undersigned adoptive child, who is
						years old, having been born on, hereby consents to (his) (her) adoption
						by
(b) . The adoptive parent(s) (has)(have)
						(no) knowledge of any criminal record concerning themselves or any other adult
						residing in the household (except)
Dated:
______________
Child
/
_________________________
Adoptive Parent: typed or printed
						name/signature
/
_________________________
Adoptive Parent: typed or printed
						name/signature
/
_________________________
Adoptive child if over 18: typed or
						printed name/signature
/
_________________________
Attorney if any: typed or printed
						name/signature
_________________________
Attorney's Address and Telephone
						number
Form 2-C page 2
STATE OF NEW YORK)
: ss.:
COUNTY OF)
On this day of, 19, before me personally
						came
, to me known and known to be the person
						described in and who executed the foregoing instrument and
duly acknowledged to me that executed the
						same.
______________
Notary Public
STATE OF NEW YORK)
: ss.:
COUNTY OF)
On this day of, 19, before me personally
						came
proven to me by the oath of
an attorney admitted to practice in the
						State of New York to be the person described in and who executed the foregoing
						instrument and
duly acknowledged that executed the
						same.
________
Judge of the Court
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 2-D - Consent of child over 14 (private-placement)

Current through Register Vol. 46, No. 28, July
					 10, 2024
D.R.L. § 111(1)(a) Form 2-D
(Consent of Child-
Private-Placement)
12/97
COURT OF THE STATE OF NEW YORK
COUNTY OF
________
In the Matter of the Adoption of A Child
						(Docket) (File) No.
Whose First Name Is
CONSENT OF CHILD
OVER 14
(Private-Placement)
________
The undersigned adoptive child, who is
						years old, having been born on, hereby consents to (his)(her) adoption by), the
						petitioning adoptive parent(s) in the above-entitled proceeding.
Dated:
______________
Child
/
_________________________
Adoptive Parent: typed or printed
						name/signature
/
_________________________
Adoptive Parent: typed or printed
						name/signature
/
_________________________
Adoptive child if over 18: typed or
						printed name/signature
/
_________________________
Attorney if any: typed or printed
						name/signature
_________________________
Attorney's Address and Telephone
						number
Form 2-D page 2
STATE OF NEW YORK)
ss.:
COUNTY OF)
On this day of, 19, before me
						personally
came
, to me known and known to me to be the
						person described in and who executed the foregoing instrument and duly
						acknowledged to me that
executed the same.
______________
Notary Public
STATE OF NEW YORK)
ss.:
COUNTY OF)
On this day of, 19, before me personally
						came
proven to me by the oath of an
attorney admitted to practice in the State
						of New York to be the person described in and who executed the foregoing
						instrument and duly acknowledged that
executed the same.
________
Judge of the Court
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 2-E - Affidavit and consent of person having lawful custody (other than birth or legal parent - private-placement)

Current through Register Vol. 46, No. 28, July
					 10, 2024
D.R.L. §§ 109(6), 111(1) (f),
						Form 2-E
115(6) (Affidavit and Consent
- Person Having Custody
Private-Placement)
12/97
SURROGATE'S COURT OF THE STATE OF NEW
						YORK
COUNTY OF
________
In the Matter of the Adoption of (Docket)
						(File) No.
A Child whose First Name Is
AFFIDAVIT AND
CONSENT
OF PERSON HAVING
LAWFUL CUSTODY
(Other than Birth
or Legal Parent-
Private-Placement)
________
STATE OF NEW YORK)
ss.:
COUNTY OF)
(b) . The adoptive parent(s) (has)(have)
						(no) knowledge of any criminal record concerning themselves or any other adult
						residing in the household (except)
(b) . The adoptive parent(s) (has)(have)
						(no) knowledge of any criminal record concerning themselves or any other adult
						residing in the household (except)
being duly sworn, depose(s) and
						say(s):
Deponent(s) reside(s) at
and (is)(are) the person(s) having lawful
						custody of the above-named adoptive child in that:
[recite facts showing how lawful custody
						was obtained]
Deponent(s) hereby consent(s) to said
						child's adoption by the petitioning adoptive parent(s) (and).
________
________
Form 2-E page 2
/
_________________________
Adoptive Parent: typed or printed
						name/signature
/
_________________________
Adoptive Parent: typed or printed
						name/signature
/
_________________________
Adoptive child if over 18: typed or
						printed name/signature
/
_________________________
Attorney if any: typed or printed
						name/signature
_________________________
Attorney's Address and Telephone
						number
STATE OF NEW YORK)
ss.:
COUNTY OF)
On this day of, 19,, the person who
						executed the foregoing instrument, personally came before me and acknowledged
						to me that (he)(she) executed the same.
______________
Notary Public
STATE OF NEW YORK)
ss.:
COUNTY OF)
On this day of, 19,, the person who
						executed the foregoing instrument, personally came before me and acknowledged
						to me that (he)(she) executed the same.
______________
Notary Public
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 2-Fa - Judicial consent (birth or legal parent - private-placement - step- parent)

Current through Register Vol. 46, No. 28, July
					 10, 2024
D.R.L. §§ 115, 115-b(8) Form
						2-Fa
(Judicial Consent -
Birth or Legal Parent-
Private-Placement
Step-parent)
12/97
COURT OF THE STATE OF NEW YORK
COUNTY OF
________
In the Matter of the Adoption of
						(Docket)(File) No.
A Child Whose First Name is
JUDICIAL CONSENT
(Birth or Legal Parent--
Private-Placement-
Step-parent)
________
1. I, [specify name]:, residing at
, (birth)(legal) parent of
[specify first name of child]:, do hereby
						consent to the adoption of my (daughter) (son), who was born on [specify date]
						by [specify name]:
, adoptive parent.
2. The full name and last known address of
						the other (birth) (legal) parent of the adoptive child are: [FN1]
Dated:
/
_________________________
(b) . The adoptive parent(s) (has)(have)
						(no) knowledge of any criminal record concerning themselves or any other adult
						residing in the household (except)
/
_________________________
Adoptive Parent: typed or printed
						name/signature
/
_________________________
Adoptive Parent: typed or printed
						name/signature
/
_________________________
Adoptive child if over 18: typed or
						printed name/signature
/
_________________________
Attorney if any: typed or printed
						name/signature
_________________________
Attorney's Address and Telephone
						number
Form 2-fa Page 2
State of)
: ss.:
County of)
On this day of, 19 ,
the person described in and who executed
						the foregoing instrument personally came before me and acknowledged that
						(he)(she) executed the same.
________
Judge of the Court
__________
(Seal of Court to be
affixed together
with Court Clerk's
certification)
[FN1] Optional
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 2-Ga - Extrajudicial consent (birth or legal parent - private-placement - step-parent)

Current through Register Vol. 46, No. 28, July
					 10, 2024
D.R.L. §§ 115, 115-b(8) Form
						2-Ga
(Extrajudicial Consent
Birth or Legal Parent -
Private-Placement
Step-parent)
12/97
COURT OF THE STATE OF NEW YORK
COUNTY OF
________
In the Matter of the Adoption of (Docket)
						(File) No.
A Child whose First Name is
EXTRAJUDICIAL CONSENT
(Birth or Legal Parent -
Private-Placement-
Step-parent)
________
1. I,, residing at
, am the (birth) (legal) parent of . I do
						hereby consent to the adoption of my (daughter)(son)
, born on
by[specify name]:, adoptive parent.
2. the name and last known address of the
						other (birth)(legal) parent of the adoptive child are:[FN1]
Dated: ________
/
_________________________
(b) . The adoptive parent(s) (has)(have)
						(no) knowledge of any criminal record concerning themselves or any other adult
						residing in the household (except)
/
_________________________
Adoptive Parent: typed or printed
						name/signature
/
_________________________
Adoptive Parent: typed or printed
						name/signature
/
_________________________
Adoptive child if over 18: typed or
						printed name/signature
/
_________________________
Attorney if any: typed or printed
						name/signature
_________________________
Attorney's Address and Telephone
						number
Form 2-ga page 2
STATE OF NEW YORK)
: ss.:
COUNTY OF)
On this day of 19,, the person who
						executed the foregoing instrument, personally came before me and acknowledged
						that (he) (she) executed the same.
______________
Notary Public
[FN1] Delete if
						inapplicable
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 3 - Order directing service of notice

Current through Register Vol. 46, No. 28, July
					 10, 2024
D.R.L. §§ 111(3), 111-a(4),
						115(9) Form 3
(Order Directing
Service of Notice)
12/97
At a term of the Court of the
State of New York, held in and for
						the
County of
at New York,
on, 19.
P R E S E N T
Hon.
Judge
________
In the Matter of the Adoption of (Docket)
						(File) No.
A Child Whose First Name Is
ORDER
DIRECTING
SERVICE OF
NOTICE
________
A petition for the adoption of the
						above-named adoptive child having been filed with this Court, and
It appearing that notice should be given
						to the person(s) hereinafter named, it is
ORDERED that notice of the filing of said
						petition requesting an order approving and allowing the said adoption be given
						to
in the following manner:
ENTER
______________
SURROGATE
Dated:, 19.
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 4 - Notice of proposed adoption

Current through Register Vol. 46, No. 28, July
					 10, 2024
D.R.L. §§ 111(3), 111-a(6),
						115(9). Form 4
(Notice of Proposed Adoption)
12/97
SURROGATE'S COURT OF THE STATE OF NEW
						YORK
COUNTY OF
________
In the Matter of the Adoption of
						(Docket)(File) No.
A Child whose First Name is
NOTICE OF PROPOSED
ADOPTION
________
To:
PLEASE TAKE NOTICE that a petition praying
						for an order approving and allowing the adoption of an adoptive child whose
						first name is, who alleged to be your (state relationship), and whose full
						name, date and place of birth is set forth in a Schedule annexed to the
						petition for adoption herein, together with an agreement to adopt and consents
						to the adoption pursuant to the Domestic Relations Law, has been filed with the
						Court of the State of New York,
County, and a hearing thereon will be held
						at the Court on the day of, 19, at o'clock in the noon of that day, at which
						time and place all persons having any interest therein will be heard.
PLEASE TAKE FURTHER NOTICE that your
						failure to appear may constitute a denial of your interest in the child which
						may result, without further notice to you, in the adoption or other disposition
						of the custody of the child.[FN1]
/
_________________________
Adoptive Parent: typed or printed
						name/signature
/
_________________________
Adoptive Parent: typed or printed
						name/signature
/
_________________________
Adoptive child if over 18: typed or
						printed name/signature
/
_________________________
Attorney if any: typed or printed
						name/signature
_________________________
Attorney's Address and Telephone
						number
[FN1] Include only where applicable
						pursuant to D.R.L. § 111-a(6)
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 5 - Order of publication

Current through Register Vol. 46, No. 28, July
					 10, 2024
D.R.L. §§ 111(3), S.C.P.A.
						307(2)(a) Form 5
(iv), CPLR 315 (Order of
						Publication
Agency)
12/97
At a term of the Court of the
State of New York, held in and for
						the
County of ,
at New York,
on, 19.
P R E S E N T
Hon.
Judge
________
In the Matter of the Adoption of
						(Docket)(File) No.
A Child whose First Name Is
ORDER OF
PUBLICATION
________
Upon reading and filing the petition
						herein duly verified on
applying for the adoption of the
						above-named person and upon the affidavit of
duly sworn to on and it appearing to the
						ascertained, it is hereby
ORDERED, that service of a copy of a
						notice of application for adoption be made upon
by publication thereof in (one) (two)
						newspaper(s), to wit: in the
published in the County of
, State of (and in the
published in the County of
State of, (once)[FN1] (not less than once
						in each of four successive weeks)[FN2], the (first) publication to be made at
						least days before the return day fixed in the said notice of application for
						adoption; and it is further
(ORDERED that on or before the day of
						first publication the petitioner deposit in a post office or in any post office
						box regularly maintained by the government of the United States in the State of
						New York a copy of said notice of application for adoption, contained in a
						securely closed, post-paid wrapper, directed to said at
that being last known address of said
						person.)
(ORDERED that the mailing of said notice
						of application for adoption is hereby dispensed with, the Court being satisfied
						by said petition and affidavit that the petitioner cannot with reasonable
						diligence ascertain a place or places where the said would probably receive the
						matter transmitted through the post office.)
ENTER
______________
(SURROGATE)
Date:
[FN1] S.C.P.A. § 307(2)(a)(iv)
[FN2] CPLR § 315 et
						seq.
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 6-A - Order for investigation (agency)

Current through Register Vol. 46, No. 28, July
					 10, 2024
D.R.L. §§ 112(7), 113 Form
						6-A
(Adoption--Order for
Investigation)
12/97
At a term of the Court of the
State of New York, held in and for
						the
County of ,
at, New York,
on, 19.
P R E S E N T:
Hon.
Judge
________
In the Matter of the Adoption of
						(Docket)(File) No.
A Child Whose First Name Is
ORDER FOR
INVESTIGATION
________
UPON reading and filing the petition,
						agreement of adoption and consents and other papers submitted herein, it
						is
ORDERED that be and hereby is designated
						and appointed to investigate the truth and accuracy of the allegations of the
						petition; and it is further
ORDERED that said investigator shall
						ascertain as fully as possible and incorporate in a report such other factors
						relating to the adoptive child and the adoptive parents as will give the court
						adequate time for determining the propriety of approving the adoption; and it
						is further
ORDERED that within thirty (30) days of
						the date of this order, unless this Court shall grant an extension of such
						period for good cause shown, said investigator shall make a written report of
						such investigation and submit the same to this Court; and it is further
ORDERED
).
ENTER
______________
SURROGATE
Date:, 19.
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 6-B - Order for investigation (private-placement)

Current through Register Vol. 46, No. 28, July
					 10, 2024
D.R.L. §§ 116 Form 6-B
(Order for Investigation
Private-Placement)
9/89
At a term of the Court of the
State of New York, held in and for
						the
County of ,
at, New York,
on, 19.
P R E S E N T:
Hon.
Judge
________
In the Matter of the Adoption of
						(Docket)(File) No.
A Child Whose First Name Is
ORDER FOR
INVESTIGATION
(Private Placement)
________
UPON reading and filing the petition,
						agreement of adoption and consents and other papers submitted herein, it
						is
ORDERED that be and hereby is designated
						and appointed to investigate the truth and accuracy of the allegations of the
						petition, and where applicable, of the statements contained in any affidavits
						required by section
						115 of
						the Domestic Relations Law; and it is further
ORDERED that said investigator shall
						ascertain as fully as possible and incorporate in a report the various factors,
						including but not limited to those set forth in section
						116
						(3) of the Domestic Relations Law, that may
						bear upon the determination of the application for adoption and it is
						further
ORDERED that within thirty (30) days of
						the date of this order, unless this Court shall grant an extension of such
						period for good cause shown, said investigator shall make a written report of
						such investigation and submit the same to this Court; and it is further
Form 6-B page 2
ORDERED that the investigator shall make
						such other and further investigations as may be required from time to time
						until the granting of the order of adoption; and it is further
ORDERED that neither the investigator
						designated herein nor any other person shall keep any copy of said report nor
						any notes or memoranda thereon and that the report of said investigation shall
						be kept by the court as a permanent record and sealed and withheld from
						inspection subject to the provisions of the Domestic Relations Law; and it is
						further
ORDERED that such investigation shall not
						unnecessarily duplicate any previous investigations which have been made to the
						petitioner(s) pursuant to section 1115-d of the Domestic Relations Law.
Dated:
ENTER
______________
(iv), CPLR 315 (Order of
						Publication
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 7 - Report of investigation (private-placement)

Current through Register Vol. 46, No. 28, July
					 10, 2024
D.R.L. § 116 Form 7
(Report of Investigation-
Private-Placement)
12/97
SURROGATE'S COURT OF THE STATE OF NEW
						YORK
COUNTY OF
________
In the Matter of Adoption of
A Child Whose First Name Is (Docket)(File)
						No.
REPORT OF
INVESTIGATION
(Private-Placement)
________
TO THE COURT OF THE COUNTY OF ;
Pursuant to the order for investigation
						dated the day of from the Honorable Judge of the Court, I,, do report that I
						have investigated the allegations set forth in the petition herein and any
						statements contained in the affidavits required by the Domestic Relations Law.
						On the basis of such investigation, I respectfully submit the following
						report:
1. The marital status, family members and
						history, religious affiliation, if any, of the adoptive parent(s) and adoptive
						child are:
;
2. The physical and mental health of the
						adoptive parent(s) and adoptive child are:
;
3. The adoptive parent(s) have an income
						of and own the following property:
4. The following fees, compensation or
						other remuneration have been paid or agreed upon with respect to the placement
						of the child for adoption:
To natural parent:
To attorney for natural parent:
Form 7 page 2
To agency:
To attorney for agency:
To attorney for adoptive parent:
Other (specify):
5. The adoptive parent(s) (has) (have) not
						been (a) respondent(s) in any proceeding involving children alleged to be
						neglected, abandoned, abused, delinquent or in need of supervision
						except:
;
6. The following other facts relating to
						the familial, social, emotional and financial circumstances of the adoptive
						parent(s) may be relevant to a determination of adoption:
Dated:, 19.
______________
Investigator
______________
Petitioner
______________
Print or type name
______________
Signature of Attorney, if any
______________
Attorney's Name (Print or Type)
________
________
______________
Attorney's Address and Telephone
						Number
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 8-A - Affidavit identifying party (agency)

Current through Register Vol. 46, No. 28, July
					 10, 2024
22 NYCRR 207.55(b)(2) Form 8-A
(Affidavit
Identifying
Party-Agency)
12/97
SURROGATE'S COURT OF THE STATE OF NEW
						YORK
COUNTY OF
________
In the Matter of Adoption of (Docket)
						(File) No.
A Child Whose First Name Is
AFFIDAVIT
IDENTIFYING
PARTY
(Agency)
________
STATE OF NEW YORK)
)ss.:
COUNTY OF)
[FN1] (That (s)he is an attorney at law
						duly licensed to practice under the laws of the State of New York and has (his)
						(her) office at
;)
That (s)he knows (and) and knows that
						s(he) (they)(is)(are) the same person(s) described in and who executed the
						annexed
(iv), CPLR 315 (Order of
						Publication
______________
Affiant
Sworn to before me this day of, 19.
______________
Judge of the Court
[FN1] Delete if
						inapplicable
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 8-B - Affidavit identifying party (private-placement)

Current through Register Vol. 46, No. 28, July
					 10, 2024
22 NYCRR 207.55(b)(2) Form 8-B
(Affidavit
Identifying Party-
Private-Placement)
12/97
SURROGATE'S COURT OF THE STATE OF NEW
						YORK
COUNTY OF
________
In the Matter of Adoption of (Docket)
						(File) No.
A Child Whose First Name Is
[FN1]AFFIDAVIT
IDENTIFYING PARTY
(Private-Placement)
________
STATE OF NEW YORK)
)ss.:
COUNTY OF)
[FN2](That (s)he is an attorney at law
						duly licensed to practice under the laws of the State of New York and has (his)
						(her) office at
;)
That (s)he knows (and
) and knows that (s)he (they (is) (are)
						the same person(s) described in and who executed the annexed (and who (is)
						(are) now present before the Court).
______________
Affiant
Sworn to before me this day of, 19.
______________
Judge of the Court
[FN1] Where the affiant is not the
						attorney of record.
[FN2] Delete if
						inapplicable
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 8-C - Affidavit identifying party (private-placement)

Current through Register Vol. 46, No. 28, July
					 10, 2024
22 NYCRR 207.55(b)(2) Form 8-C
(Affidavit
Identifying
Party-
Private-Placement)
12/97
SURROGATE'S COURT OF THE STATE OF NEW
						YORK
COUNTY OF
________
In the Matter of Adoption of (Docket)
						(File) No.
A Child Whose First Name Is
[FN1]AFFIDAVIT
IDENTIFYING
PARTY
(Private-Placement)
________
STATE OF NEW YORK)
)ss.:
COUNTY OF)
, being duly sworn, deposes and
						says:
That (s)he is an attorney at law duly
						licensed to practice under the laws of the State of New York and has (his)
						(her) office at
.
That (s)he knows (and
) and knows that s(he)(they (is)(are) the
						same person(s) described in and who executed the annexed instrument (and who
						(is)(are) now present before the Court).
That (s)he believes that the adoption by
						the proposed adoptive parent(s),
(iv), CPLR 315 (Order of
						Publication
That (s)he believes that the proposed
						adoptive parent(s) (is) (are) person(s) of sufficient means, and (is) (are) fit
						and proper person(s) to have the care and custody of said adoptive
						child.
______________
Affiant
Sworn to before me this day of 19.
______________
Judge of the Court
[FN1] Where the affiant is the attorney of
						record.
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 9-A - Affidavit of financial disclosure - parents (agency)

Current through Register Vol. 46, No. 28, July
					 10, 2024
S.S.L. § 374(6); Form 9-A
22 NYCRR 207.55(b)(8) (Affidavit of
						Financial
Disclosure - Parents
- Agency)
12/97
SURROGATE'S COURT OF THE STATE OF NEW
						YORK
COUNTY OF
________
In the Matter of the Adoption of (Docket)
						(File) No.
A Child whose First Name is
AFFIDAVIT OF
FINANCIAL
DISCLOSURE -
PARENTS
(Agency)
________
STATE OF NEW YORK)
ss:
COUNTY OF)
(and)
being duly sworn, depose(s) and
						say(s):
1. That deponent(s) reside(s) at
and (is) (are)
the (petitioning adoptive parent(s))
						(birth or legal parent(s)) of the above-named adoptive child; and
2. That deponent(s) (has) (have) paid or
						given or caused to be paid or given or undertaken to pay or give the following
						expenses, contributions, compensation or things of value, either directly or
						indirectly, to any person, agency, association, corporation, institution,
						society or organization, in connection with the placing out of said adoptive
						child with deponent(s) or with the adoption of said child by
						deponent(s):
[Specify recipient, amount, form, and
						purpose of each payment. If none, so state.]
;
3. That deponent(s) (has) (have)
						requested, received or accepted, either directly or indirectly, the following
						compensation or things or value from any person, agency, association,
						corporation, institution, society or other organization in connection with the
						placing out of said adoptive child with
Form 9-A page 2
deponent(s) or with the adoption of said
						child by deponent(s).
[Specify source, amount, form
and purpose of each payment
requested or received. If none,
so state.]
/
[FN ]
_________________________
*(Adoptive)(Birth)(Legal) Parent: typed or
						printed name/signature
/
_________________________
*(Adoptive)(Birth)(Legal) Parent: typed or
						printed name/signature
/
_________________________
Adoptive child if over 18: typed or
						printed name/signature
/
_________________________
Attorney if any: typed or printed
						name/signature
_________________________
Attorney's Address and Telephone
						number
Sworn to before me this day of, 19.
________
Judge of the Court
[FN ] Delete inapplicable
						provisions