Fill and Sign the Form 15 B

D.R.L.§114Form 15-B (Order for Certified Copy of Adoption Order-Before sealing of records) 9/99 At a term of the Surrogate’s Court of the State of New York, held in and for the County of ,at , New Yorkon . PRESENT: Hon. Judge In the matter of the Adoption of (Docket)(File) No. ORDER FOR CERTIFIED COPY OF ADOPTION ORDER A Minor of the Age of years (Before sealing of records) UPON reading and filing the application of and duly verified the day of , , requesting this Court to issue an order authorizing the Clerk of the Court of the County of to prepare, certify and deliver to said applicant (s) a copy of the original order of adoption granted herein; and the Court being satisfied that there is good and proper cause for granting such request; and upon all of the proceedings had herein; it is ORDERED that the Clerk of the Court of the County of be and (s)he hereby is authorized to prepare, certify and deliver to said applicant (s) a copy of the original order of adoption granted herein., Form 15-B page 2 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 LAW GUARDIAN UPON THE APPELLANT, WHICHEVER IS EARLIEST. ENTER Dated: , . (J.F.C.) (Surrogate) Check applicable box: ‘ Order mailed on [specify date(s) and to whom mailed]:_______________________ ‘ Order received in court on [specify date(s) and to whom given]:_________________