Application and Order Re - Superior Court of California

123In the Matter of: _____________________________ Case Number: ____________________Family Code Section 9200 prohibits release of any adoption information “except in exceptionalcircumstances and for good cause approaching the necessitous”.456Reason for request and facts in support of request (attach corroborative documents, ifappropriate):78910111213141516171819202122232425I declare under penalty of perjury that the foregoing is true and correct:26272829Date: ______________________ Signature: ____________________________________Print name: ___________________________________See next page for Declarations outside the State of California.Page 2Electronic format by: A. Birdsong 12.3.08

1234In the Matter of: _____________________________Case Number: _____________________*Note: The form of declaration under penalty of perjury is to be used only when executed in theState of California. If this document is executed outside the State of California, this form is to beexecuted before a Notary Public or other officer authorized to administer oaths.56Subscribed and sworn to and before me on: ________________________________78(Seal) __________________________________Notary Public9101112ORDER_______The request for disclosure of adoption information is hereby denied. There is insufficientshowing as required by Family Code Section 9200.1314151617_______Good cause appearing, the request for disclosure of adoption information is herebygranted. The Court finds, in balancing the rights of all concerned individuals, that exceptionalcircumstances exist necessitating the release of the information herein requested. The informationherein requested shall be released to the requesting party.1819202122232425262728Date: ___________________////////////________________________________________Judge of the Superior Court29Page 3Electronic format by: A. Birdsong 12.3.08