Fillable FORM 12.981(d)(1),: INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED (Florida)

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FORM 12.981(d)(1),: INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED (Florida)

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INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW
FORM 12.981(d)(1),
PETITION FOR ADOPTION INFORMATION
(03/15)
When should this form be used?
This form is used to request release of relevant medical or social information on an adoptee. You cannot use
this form to find out the identity of birth parent(s).
This form should be typed or printed in black ink. After completing this form, you should sign the form
before a notary public or deputy clerk. You should file the original with the clerk of the circuit court in the
county where the adoption took place and keep a copy for your records.
IMPORTANT INFORMATION REGARDING E-FILING
The Florida Rules of Judicial Administration now require that all petitions, pleadings, and documents be filed
electronically except in certain circumstances. Self-represented litigants may file petitions or other
pleadings or documents electronically; however, they are not required to do so. If you choose to file your
pleadings or other documents electronically, you must do so in accordance with Florida Rule of Judicial
Administration 2.525, and you must follow the procedures of the judicial circuit in which you file. The rules
and procedures should be carefully read and followed.
Special notes...
Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these
forms, that person must give you a copy of Disclosure from Nonlawyer, Florida Family Law Rules of
Procedure Form 12.900 (a), before he or she helps you. A nonlawyer helping you fill out these forms also
must put his or her name, address, and telephone number on the bottom of the last page of every form he
or she helps you complete.
Instructions for Florida Supreme Court Approved Family Law Form 12.981(d)(1), Petition for Adoption Information
(03/15)
_____________________________________________
IN THE CIRCUIT COURT OF THE JUDICIAL CIRCUIT,
IN AND FOR COUNTY, FLORIDA
Case No.:
Division:
IN RE: THE ADOPTION OF
____________________________________,
Adoptee(s).
PETITION FOR ADOPTION INFORMATION
1. I, {full legal name} , am interested in this matter as:
{choose one only}
__adult adoptee (over 18).
__adoptive parent.
__adult birth sibling.
__other:{specify} .
2. The adoptee(s), {name(s)}
was (were) born on {date} .
3. I request nonidentifying information as to family medical history and social history of the adoptee(s)
as follows:
{indicate all that apply}
_____If available, to be furnished to adoptive parents before finalization of the adoption.
_____ If available, to be furnished to adoptee upon request after adoptee reaches majority.
4. The reason I am requesting disclosure of this information is:
.
I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this
petition and that the punishment for knowingly making a false statement includes fines and/or
imprisonment.
Dated:
Signature of Petitioner
Printed Name:
Address:
City, State, Zip:
Telephone Number:
Fax Number:
Designated E-mail Address(es): ____________________
Florida Supreme Court Approved Family Law Form 12.981(d)(1), Petition for Adoption Information (03/15)
STATE OF FLORIDA
COUNTY OF
Sworn to or affirmed and signed before me on by:
NOTARY PUBLIC or DEPUTY CLERK
{Print, type, or stamp commissioned name of notary or
deputy clerk.}
__Personally known
__Produced identification
Type of identification produced
IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW:
[fill in all blanks] This form was prepared for the: {choose only one} ( ) adult adoptee
( ) adoptive parent ( ) adult birth sibling ( ) other {specify}______________________________.
This form was completed with the assistance of:
{name of individual} ____________________________________________________________________,
{name of business} ______________________________________________________________________,
{address} ______________________________________________________________________________,
{city} _______________, {state} ______, {zip code} __________, {telephone number} __________________.
Florida Supreme Court Approved Family Law Form 12.981(d)(1), Petition for Adoption Information (03/15)
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FORM 12.981(d)(1),: INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED (Florida)

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Completed 10 January 2021

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