Fill and Sign the Petition for Adoption Information Florida

INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.981(d)(1), PETITION FOR ADOPTION INFORMATION (03/15) When should this form be used? This form is used to request release of relevant medical or social information on an adoptee. You cannot use this form to fnd out the identity of birth parent(s). This form should be typed or printed in black ink. After completing this form, you should sign the form before a notary public or deputy clerk . You should fle the original with the clerk of the circuit court in the county where the adoption took place and keep a copy for your records. IMPORTANT INFORMATION REGARDING E-FILING The Florida Rules of Judicial Administration now require that all petitions, pleadings, and documents be fled electronically except in certain circumstances. Self- represented litigants may fle petitions or other pleadings or documents electronically; however, they are not required to do so. If you choose to fle your pleadings or other documents electronically, you must do so in accordance with Florida Rule of Judicial Administration 2.525, and you must follow the procedures of the judicial circuit in which you fle. The rules and procedures should be carefully read and followed. Special notes... Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fll out these forms, that person must give you a copy of Disclosure from Nonlawyer , Florida Family Law Rules of Procedure Form 12.900 (a), before he or she helps you. A nonlawyer helping you fll out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete. Instructions for Florida Supreme Court Approved Family Law Form 12.981(d)(1), Petition for Adoption Information (03/15) IN THE CIRCUIT COURT OF THE JUDICIAL CIRCUIT, IN AND FOR COUNTY, FLORIDA Case No.: Division: IN RE: THE ADOPTION OF ____________________________________, Adoptee(s). PETITION FOR ADOPTION INFORMATION 1. I, {full legal name} , am interested in this matter as: {choose one only} __adult adoptee (over 18). __adoptive parent. __adult birth sibling. __other: {specify} . 2. The adoptee(s), {name(s)} was (were) born on {date} . 3. I request nonidentifying information as to family medical history and social history of the adoptee(s) as follows: {indicate all that apply} _____If available, to be furnished to adoptive parents before fnaliiation of the adoption. _____ If available, to be furnished to adoptee upon request after adoptee reaches majority. 4. The reason I am requesting disclosure of this information is: . I understand that I am swearing or afrming under oath to the truthfulness of the claims made in this petition and that the punishment for knowingly making a false statement includes fnes and/or imprisonment. Dated: Signature of Petitioner Printed Name: Address: City, State, Zip: Telephone Number: Florida Supreme Court Approved Family Law Form 12.981(d)(1), Petition for Adoption Information (03/15) Fax Number: Designated E-mail Address(es): ____________________ _____________________________________________ STATE OF FLORIDA COUNTY OF Sworn to or afrmed and signed before me on by: NOTARY PUBLIC or DEPUTY CLERK {Print, type, or stamp commissioned name of notary or deputy clerk.} __ Personally known __ Produced identifcation Type of identifcation produced IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [fll in all blanks] This form was prepared for the: {choose only one} ( ) adult adoptee ( ) adoptive parent ( ) adult birth sibling ( ) other {specify} ______________________________. This form was completed with the assistance of: {name of individual} ____________________________________________________________________, {name of business} ______________________________________________________________________, {address} ______________________________________________________________________________ , {city} _______________, {state} ______, {zip code} __________, {telephone number} __________________. Florida Supreme Court Approved Family Law Form 12.981(d)(1), Petition for Adoption Information (03/15)