Fill and Sign the Form 26 a Download Fillable PDF Affidavit and Report

D.R.L. §§ 115, 115-d(9)Form 26(Certification Petition for Extension of Expired Certification - Private Placement) 9/99.................................................................In the Matter of the Adoption ofA Child whose First Name is (Docket)(File) No. PETITIONby Adoptive Parent(s) FOR EXTENSION OF EXPIRED CERTIFICATION (Private Placement)...................................................................The Petitioner(s) respectfully allege(s) to this Court that:1. (He)(She)(They) filed a petition to adopt the above-described child in this Court on , .2. Petitioner(s) (was)(were) certified as a qualified adoptive parent(s), by order of the Court, County of , dated , , which order expired on , , within one yearprior to the filing of the adoption petition.3. The following change(s) in circumstances relevant and material to such certification (has)(have)taken place since issuance and expiration of the last certification:4. Submitted herewith is written verification of any such change in circumstances or lack thereof by , a disinterested person as defined in section 115-d(4) of the Domestic Relations Law.WHEREFORE, Petitioner(s) (prays) (prays) for an order extending the termination date of the earliercertification until eighteen months from the date of filing of the adoption petition, that is,______________________________________/______________________________Adoptive Parent: typed or printed name/ signature________________________________________________/_____________________Adoptive Parents: typed or printed name/ signature_______________________________________/______________________________Attorney: typed or printed name/ signature___________________________________________________________Attorney’s Address and Telephone Number Form 26 page 2VERIFICATIONSTATE OF NEW YORK ) ss:COUNTY ) being duly sworn, says that (he)(she) (they)(is)(are) the Petitioner(s) in the above-named proceeding and thatthe foregoing petition is true to (his)(her)(their) own knowledge, except as to matters therein stated to bealleged on information and belief and as to those matters (he)(she) (they) believe(s) it to be true.______________________________________/_____________________________Adoptive Parent: typed or printed name/ signature______________________________________/_____________________________Adoptive Parent: typed or printed name/ signatureSworn to before me this day of , ._______________________________(Deputy)Clerk of the Court Notary PublicResworn to before me this day of , .________________________________Judge of the Court