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-A - Order of adoption (agency)

Current through Register Vol. 46, No. 28, July
					 10, 2024
D.R.L. §§ 111, 112(b), 113, 114
						Form 13-A
(Order of Adoption -
Agency)
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
(Agency)
________
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 the adoptive child having the given first name
						of
and whose full name is, and whose birth
						day is, 19, and who was born at as set forth in the verified schedule annexed
						to the petition for adoption herein, said schedule 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]
;
AND the aforesaid petitioning adoptive
						parent(s) and the adoptive child and all other persons whose consents are
						required as aforesaid having personally appeared before this Court for
						examination, except
;
Form 13-a Page 2
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 that the verified report of, the
						authorized agency, dated, is hereby accepted, pursuant to section
						113 of
						the Domestic Relations Law, as the report of investigation required by section
						112 of
						the Domestic Relations Law;)
AND the adoptive child having resided with
						the petitioning adoptive parent(s) since (and the judge having dispensed with
						the three-month period of residency with the adoptive parent(s), pursuant to
						section
						112 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 (delete if inapplicable provisions)
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
						petitioner(s) 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
Form 13-a Page 3
(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; any 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 parent(s); and it is
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.