Fill and Sign the Hospital Birth Certificate Form

IN THE _______________________ (Name of Court) OF ___________________ (Name of County), ___________________________________ (State) In the Matter of the Adoption of _____________________, a Minor Case Number: _____-_____ Application for Order to Obtain Hospital Photocopy of Birth Certificate Comes now ________________________ (Name of Attorney), attorney for Petitioners herein , and files this Application for an Order requiring ___________________________ (Name of Hospital) to send, within ___days of the date of this Application, to Applicant, as the attorney of record for Petitioners, a hospital photocopy of the birth certificate of the minor, ____ _______ ____________ , and would state in support thereof the following: I. ________________________________, the minor who is the subject of this proceeding, was born on ____________ (date) , at _____________________________________ (Name of Hospital) in __________________________________________ (Name of County and State). II. The _____________________________________ (e.g., county health department) has advised the undersigned that it cannot issue a certified copy of the minor's birth certificate in less than ___days. Under _________________________ ( cite applicable statute) , all parties to the adoption must be interviewed by the ___________________________________________ (e.g., state department of health) or a licensed _______________________________________ (e.g., county adoption agency) within ____days of the filing of a Petition for Adoption. The regulations of the state department of health provide that neither the state department of health nor the licensed _____________________________________________ (e.g., county adoption agency) may interview natural parents without verification of the child's birth registration by either a certified copy or a hospital photocopy of the birth certificate. WHEREFORE, the undersigned applicant requests that _________________________________________________ (Name of Hospital) be ordered to send, within ___days of the date of this Application, to Applicant, as the attorney of record for Petitioners, a hospital photocopy of the birth certificate of the minor, ______________________. RESPECTFULLY SUBMITTED this the ____ day of ____________, 20____. ______ ________________________ (Name of Attorney)