Fillable Form 13 21912 360 (Superior Court of California)

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Form 13 21912 360 (Superior Court of California)

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Form 13-21912-360 APPLICATION AND ORDER TO OBTAIN COPIES Family Code §9200
Rev 8/18/16 FROM ADOPTION CASE AND ORDER
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:
APPLICATION TO OBTAIN COPIES FROM ADOPTION CASE AND ORDER
CASE NUMBER:
If you do not know the case number, enclose a $15.00 research fee plus a self-addressed stamped envelope for the
return of the documents. If you are the original petitioner of the adoption, enclose a copy of your driver license.
I, _____________________________________________, do hereby request the court for permission to obtain a copy or
certified copy of the following:
□ Adoption Order □ Adoption Request □ Adoption Agreement
□ Other: __________________________________________________________________________________________
If you do not know the case the number complete items 1 through 4
1. Child’s name: __________________________________________ Child’s date of birth _____________________
2. City and State where the adoption took place:______________________________________________________
3. Date or approximate date of adoption: ___________________________ Type of adoption: _________________
4. Adopting parent’s name: _______________________________________________________________________
5. Relationship to adopted individual: _______________________________________________________________
6. Reason for the request: (may attach additional pages)
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
I declare under penalty of perjury under the laws of the State of California that the information above is true and
correct.
Date: ____________________________ Signature: ___________________________________________
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Form 13-21912-360 APPLICATION AND ORDER TO OBTAIN COPIES Family Code §9200
Rev 8/18/16 FROM ADOPTION CASE AND ORDER
Case Name:
Case Number:
ORDER
□ Denied □ Set for Hearing: ______________________________________________________________
□ Good cause appearing therefore, permission is hereby granted the above named applicant to obtain a copy and/or
certified copy of the following:
□ Adoption Order □ Adoption Request □ Adoption Agreement
□ Other: _________________________________________________________________________________________
/
/
/
Dated: __________________ __________________________________________
Judicial Officer of Superior Court
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Form 13 21912 360 (Superior Court of California)

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Completed 19 July 2020

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