N.Y. Comp. Codes R. & Regs. tit. 22, subtit. D, ch. VII, subch. B, Adoption Forms, form 14
D.R.L. § 114 Form 14
(Certificate of Adoption)
12/97
SURROGATE'S COURT OF THE STATE OF NEW YORK
COUNTY OF
CERTIFICATE OF ADOPTION
I,, Clerk of the
Court of County, do hereby certify that I have inspected the records of this Court and find that:
AN ORDER OF ADOPTION was signed on the day of, 19, by Honorable, Judge of the Court of the County of, granting the petition of (and), adoptive parent(s) of a child now known and called by the name of, who was born at, on the day of, 19.
This certificate as to the facts recited herein shall have the same force and effect as a certified copy of an order of adoption.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of the
Court of the County of
this day of, 19.
______________
Clerk of the Court
of the County of
N.Y. Comp. Codes R. & Regs. tit. 22, subtit. D, ch. VII, subch. B, Adoption Forms, form 14