Fillable Form 13 21907 360 (Superior Court of California)

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Form 13 21907 360 (Superior Court of California)

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The Form 13 21907 360 (Superior Court of California) form is 2 pages long and contains:

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  • 29 other fields

Country of origin: US
File type: PDF

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Form 13-21907-360 PETITION TO OBTAIN ORIGINAL UNSEALED/UN-REDACTED Health & Saf. Code §102705
Rev 08/18/16 BIRTH CERTIFICATE Family Code §9200
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address):
TELEPHONE NO.: FAX NO.:
EMAIL ADDRESS:
ATTORNEY FOR (Name):
FOR COURT USE ONLY
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
STREET ADDRESS:
MAILING ADDRESS:
CITY AND ZIP CODE:
BRANCH NAME:
IN THE MATTER OF:
PETITION TO OBTAIN ORIGINAL UNSEALED/UN-REDACTED
BIRTH CERTIFICATE
CASE NUMBER:
To request a copy of original birth certificate, complete this form and attach a copy of a valid photo identification or driver license.
1. Petitioner’s name and permanent residence address: ________________________________________________
___________________________________________________________________________________________
2. Adoptee’s date of birth and current age:
___________________________________________________________________________________________
3. Adoptee’s place of birth (city and state):
___________________________________________________________________________________________
4. Provide the following information:
a) Name of adoptive parents: __________________________________________________________________
b) Place of adoption (county in California): _______________________________________________________
c) Date of adoption: _________________________________________________________________________
5. I request permission to obtain a copy of original birth certificate of the named person for the following reasons:
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
__________________________________________________________________________
□ Attachment to 5
6. Relationship to adopted individual: ______________________________________________________________
Form 13-21907-360 PETITION TO OBTAIN ORIGINAL UNSEALED/UN-REDACTED Health & Saf. Code §102705
Rev 08/18/16 BIRTH CERTIFICATE Family Code §9200
Name of Case:
Case Number:
VERIFICATION
I am the petitioner in the above matter. I have read the foregoing Petition and know the contents thereof. I
declare that the same is true of my own knowledge, except as to those matters which are therein stated upon
my information and belief, and as to those matters I believe them to be true.
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct
Executed on _________________________ at _____________________________________________________
_______________________________________ _____________________________________________
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Form 13 21907 360 (Superior Court of California)

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Completed 18 July 2020

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