Sonoma — Declaration and Order to Unseal Unredacted Original Birth Certificate FL-094b

Source: https://sonoma.courts.ca.gov/system/files/forms-and-filings/fl-094b-3326_1.pdf

Name, Address of Petitioner or Attorney Telephone No.

Petitioner SUPERIOR COURT OF CALIFORNIA, COUNTY OF SONOMA 3055 Cleveland Avenue Santa Rosa, CA 95403 In the Matter of the Petition of:

DECLARATION AND ORDER TO UNSEAL CASE NUMBER:
UNREDACTED ORIGINAL BIRTH CERTIFICATE
(California Health and Safety Code 102705)

I,,declare as follows: I am the petitioner in the above-entitled matter. I was born on (date), in______ (city), _______________ County, State of California. I was adopted by _____________________________________________. After reviewing copies of my birth records, I feel these records are not sufficient. I need the original birth certificate because:

Enclosed is the VS-111 and a $25 check made payable to CDPH Vital Records. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.

Date:________________ SIGN

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Type or Print Name Signature

ORDER

IT IS SO ORDERED that the Office of Vital Records unseal the original unredacted birth certificate on which the child‘s birth parents are stated and forward an intact certified copy no later than two months from the date of this order to: Petitioner:________________________________ Address:_________________________________

SIGNCity, State & Zip:__________________________

Date:____________ ___________________________________________ JUDGE OF THE SUPERIOR COURT

Form Number: FL-094(b) DECLARATION AND ORDER TO UNSEAL HS § 102705 Revised Date: 1/1/19 UNREDACTED ORIGINAL BIRTH CERTIFICATE