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INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.981(d)(1), PETITION FOR ADOPTION INFORMATION 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 find 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 file the original with the clerk of the circuit court in the county where the adoption took place and keep a copy for your records. Special notes... Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of Disclosure from Nonlawyer, O` Florida Family Law Rules of Procedure Form 12.900 (a), before he or she helps you. A nonlawyer helping you fill 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 (03/02)

IN THE CIRCUIT COURT OF THE IN AND FOR

JUDICIAL CIRCUIT, COUNTY, FLORIDA Case No.: Division:

IN RE: THE ADOPTION OF

, Adoptee(s).

PETITION FOR ADOPTION INFORMATION 1. I, {full legal name} [ / one only] adult adoptee (over 18). adoptive parent. adult birth sibling. other:{specify} The adoptee(s), {name(s)} was (were) born on {date} , am interested in this matter as:

.

2.

.

3.

I request nonidentifying information as to family medical history and social history of the adoptee(s) as follows: [ / all that apply] If available, to be furnished to adoptive parents before finalization of the adoption. If available, to be furnished to adoptee upon request after adoptee reaches majority. The reason I am requesting disclosure of this information is: .

4.

I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this petition and that the punishment for knowingly making a false statement includes fines and/or imprisonment. Dated: Signature of Party
Printed Name: Address: City, State, Zip: Telephone Number: Fax Number:

STATE OF FLORIDA COUNTY OF

Florida Supreme Court Approved Family Law Form 12.981(d)(1), Petition for Adoption Information (03/02)

Sworn to or affirmed 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 identification Type of identification produced IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [ N fill in all blanks] I, {full legal name and trade name of nonlawyer} , , {city} , a nonlawyer, located at {street} , {phone} , helped {name} , {state} , fill out this form. who is the

Florida Supreme Court Approved Family Law Form 12.981(d)(1), Petition for Adoption Information (03/02)