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Domestic Relations Law §112-b Adoption Form 17 (Agency Adoption– Petition for Enforcement of Post-adoption Contact Agreement After Adoption Finalization) (8/2010) FAMILY COURT OF THE STATE OF NEW YORKCOUNTY OF......................................................................................... In the Matter of a Post-adoption Docket No. Contact Agreement Concerning PETITION FOR ENFORCEMENT OF POST-ADOPTION CONTACT Child’s Name: AGREEMENT (After Adoption Date of Birth: Finalization) Pursuant to Section 112-b of the Domestic Relations Law ........................................................................................ NOTICE: WILLFUL FAILURE TO OBEY THE TERMS AND CONDITIONS OF AN ORDER OF THE FAMILY COURT MAY RESULT IN COMMITMENT TO JAIL FOR A TERM NOT TO EXCEED SIX MONTHS. TO THE FAMILY COURT OF THE COUNTY OF [specify]: : The undersigned Petitioner respectfully alleges upon information and belief that: 1. Petitioner, [specify]: , is [check applicable box]: G an authorized agency having its office and place of business at [specify]: in the County of [specify]: , State of New York;G a party to a post-adoption contact agreement regarding the above-named child; G the attorney for the above-named child. 2. On [specify date]: , in conjunction with the surrender of the child, the Family Court, County, approved a Post-adoption Contact Agreement regarding the above-named child as being in the child’s best interests. This Post-adoption Contact Agreement was incorporated into the Order of Adoption by the [specify Court and County]: G Family G Surrogate’s Court, County, on [specify date]: . True copies of the Order of Incorporation and the Post- adoption Contact Agreement are attached to this petition. 3. The following Respondent [specify]: has violated the Post-adoption Contact Agreement as follows [specify facts and circumstances, including dates]: 4. Enforcement of the terms and conditions of the Post-adoption Contact Agreement is in the best interests of the child because [specify]: Adoption Form 17 Page 2 5. No previous application has been made for enforcement of the Post-adoption Contact Agreement to any court or judge, except [specify; delete if inapplicable]: . WHEREFORE, Petitioner requests that this Court enter an order enforcing the Post-adoption Contact Agreement. Petitioner Print or type name Signature of Attorney, if any Attorney’s Name (Print or Type) Attorney’s Address and Telephone # VERIFICATION STATE OF NEW YORK ) )SS.: COUNTY OF ) ,being duly sworn, deposes and says: That (s)he is and is acquainted with the facts and circumstances of the above-entitled proceeding; that (s)he has read the foregoing petition and knows the contents thereof; that the same is true to (his)(her) own knowledge except as to those matters therein stated to be alleged upon information and belief, and that as to those matters (s)he believes it to be true. Petitioner Sworn to before me this day of , . (Deputy) Clerk of the Court Notary Public