El Dorado — Petition for Authorization to Inspect Records

Source: https://www.eldorado.courts.ca.gov/system/files/6-petition-inspect.pdf

ATTORNEY OR PARTY WITHOUT ATTORNEY TELEPHONE NO. FOR COURT USE ONLY

ATTORNEY FOR (Name)

SUPERIOR COURT OF CALIFORNIA, COUNTY OF STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME:

PETITIONER/PLAINTIFF:

RESPONDENT/DEFENDANT:

CASE NUMBER

PETITION FOR AUTHORIZATION TO INSPECT

ADOPTION AND BIRTH RECORD INFORMATION

I, ________________________________, declare as follows:

1. My name is:

2. My permanent residence is:

My telephone number is:

3. I was born on (date), and am now years of age.

4a. I am informed and believe that I was adopted by: and

on or about

in the court of -or- .

4b. I am informed that an adoption proceeding relating to (adoptee)

was completed in the county of State of California.

On or about (date): by:

and adoptive petitioner:

1 RevisedLocal Form01/2012A6

Petitioner:: Case No:

5a. ( ) I request permission to inspect the records and/or obtain copies of the records relating to the named person for the following reasons (Civil Code §229.10 requires a showing of good cause approaching necessitous) :

(If additional space is required, attach a separate sheet) (Item 6 shall be completed by the Court Clerk)

5b. ( ) I also request permission to inspect and/or copy the original birth record for the following reasons (Health & Safety §102705 requires good and compelling cause):

(If additional space is required, attach a separate sheet) (Item 7 &8 shall be completed by the Court Clerk for further processing of this request)

WHEREFORE, I request an order of the Superior Court as required by Civil Code §229.10 and/or Health and Safety Code §102705 with respect to the records relating to the above proceeding.

Date: (Signature of requestor)

STATE OF CALIFORNIA ) VERIFICATION

COUNTY OF )

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 matter, I believe them to be true.

I declare under penalty of perjury that the foregoing is true and correct.

Dated this day of 20 , at

California.

(Signed)

2 RevisedLocal Form01/2012A6

Petitioner: Case No:

SUBMIT AS FOLLOWS:

Original and Duplicate for 5a (Court File only) FC§9203

Original and 2 copies for 5b (Information and records which may not be on record in court file) H&S§102705

Applicable for 5a only court file only (FC§9203)

COURT ORDER

The Court, having considered the verified petition ORDERS the Clerk to furnish Petitioner with a copy of the following documents, upon payment of any fees required by law:

Dated:

JUDGE OF THE SUPERIOR COURT

FOR TRANSMITTAL USE: TO BE SENT TO SACRAMENTO ONLY IF 5B IS REQUESTED (For information and records pursuant to H&S§102705)

STATE DEPARTMENT OF SOCIAL SERVICES Adoption Branch 744 P Street M/S 19-67 Sacramento, CA 95814

The original of the above petition was filed in the office for the undersigned on:

Please comply with the provisions of section 102705 of the Health and Safety Code.

Executive Officer/Clerk of the Superior Court, State of California, County of

Dated: By: , Deputy Clerk

Clerk’s notation: Copy transmitted to the State Department of Social Services on:

Petitioner:
Case No:
3 RevisedLocal Form01/2012A6

Judge of the Superior Court (Adoption Proceeding)

Attached hereto are the records received by the undersigned from the State Department of Social Services after transmission of a copy of the above verified petition to said department.

Executive Officer/Clerk of the Superior Court, State of California, County of _______

Dated: By: , Deputy Clerk

6. APPLICABLE ONLY AFTER THE COURT HAS REVIEWED SAID RECORDS RECEIVED FROM SOCIAL SERVICES.

   COURT ORDER

The Court having reviewed all of the attached records received from the State Department of Social Service and the foregoing verified petition and finding that good and compelling cause exists, now makes the following ORDER:

The Bureau of Vital Statistics shall furnish Petitioner with a copy of the original birth record upon payment of the fee required by law.

Dated: ________

JUDGE OF THE SUPERIOR COURT

DISTRIBUTION: Original – Court File Duplicate – Petitioner Duplicate – State Department of Social Services

4 RevisedLocal Form01/2012A6