Fill and Sign the 3072aiv Form

D.R.L.§§ 111(3), S.C.P.A. 307(2)(a)(iv),Form 5 CPLR 315 (Adoption--Order of Publication--Agency) 8/2010 At a term of the Court of the State of New York, held in and for the County of , at New York, on , . P R E S E N T Hon. Judge __________________________________________ In the Matter of the Adoption of (Docket) (File) No. A Child whose First Name Is ORDER OF PUBLICATION __________________________________________ Upon reading and filing the petition herein duly verified on applying for the adoption of the above-named person and upon the affidavit of duly sworn to on and it appearing to the satisfaction of the Court that the present whereabouts of are unknown and cannot, after due diligence, be ascertained, itis hereby ORDERED, that service of a copy of a notice of application for adoption be made upon by publication thereof in the following newspaper(s) [specify]: published in the County of , State of and in the published in the County of State of , Qonce Qnot less than once in each of four successive weeks , 1 2 the (first) publication to be made at least days before the return day fixed in the notice of application for adoption; and it is further QORDERED that on or before the day of first publication the petitioner deposit in a post office or in any post office box regularly maintained by the government of the United States in the State of New York a copy of the notice of application for adoption, contained in a securely closed, post-paid wrapper, directed to said at that being last known address of the person. S.C.P.A. § 307(2)(a)(iv) 1 CPLR 315 et seq 2 Form 5 page 2 Q ORDERED that the mailing of the notice of application for adoption is hereby dispensed with, the Court being satisfied by the petition and affidavit that the petitioner cannot with reasonable diligence ascertain a place or places where the would probably receive the matter transmitted through the post office. PURSUANT TO SECTION 1113 OF THE FAMILY COURT ACT, AN APPEAL FROM THIS ORDER MUST BE TAKEN WITHIN 30 DAYS OF RECEIPT OF THE ORDER BY APPELLANT IN COURT, 35 DAYS FROM THE DATE OF MAILING OF THE ORDER TO APPELLANT BY THE CLERK OF COURT, OR 30 DAYS AFTER SERVICE BY A PARTY OR THE ATTORNEY FOR THE CHILD UPON THE APPELLANT, WHICHEVER IS EARLIEST. ENTER ________________________________________ Judge of the Family Court / Surrogate Date: Check applicable box: 9 Order mailed on [specify date(s) and to whom mailed]:__________________________ 9 Order received in court on [specify date(s) and to whom given]:___________________