22 CRR-NY D IV B Form 9-ANY-CRR
STATE COMPILATION OF CODES, RULES AND REGULATIONS OF THE STATE OF NEW YORK
TITLE 22. JUDICIARY
SUBTITLE D. FORMS
CHAPTER IV. FORMS OF THE FAMILY COURT OF THE STATE OF NEW YORK AND ADOPTION FORMS OF THE FAMILY COURT OF THE STATE OF NEW YORK (CF. § 205.7)
SUBCHAPTER B. ADOPTION FORMS OF THE FAMILY COURT
ADOPTION FORMS
22 CRR-NY D IV B Form 9-A
22 CRR-NY D IV B Form 9-A
9-A Affidavit of financial disclosure - parents (agency)
S.S.L. § 374(6);
Form 9-A
22 NYCRR 205.53(b)(8)
(Affidavit of Financial
Disclosure - Parents
- Agency)
9/99
FAMILY COURT OF THE STATE OF NEW YORK
COUNTY OF
________________
In the Matter of the Adoption of
(Docket) (File) No.
A Child whose First Name is
AFFIDAVIT OF FINANCIAL DISCLOSURE - PARENTS (Agency)
________________
STATE OF NEW YORK
)
ss:
COUNTY OF
)
(and
)
being duly sworn, depose(s) and say(s):
1. That deponent(s) reside(s) at
and (is) (are) the (petitioning adoptive parent(s) (birth or legal parent(s)) of the above-named adoptive child; and
2. That deponent(s) (has) (have) paid or given or caused to be paid or given or undertaken to pay or give the following expenses, contributions, compensation or things of value, either directly or indirectly, to any person, agency, association, corporation, institution, society or organization, in connection with the placing out of said adoptive child with deponent(s) or with the adoption of said child by deponent(s):
[Specify recipient, amount, form, and purpose of each payment. If none, so state.]
;
3. That deponent(s) (has) (have) requested, received or accepted, either directly or indirectly, the following compensation or things or value from any person, agency, association, corporation, institution, society or other organization in connection with the placing out of said adoptive child with
Form 9-A page 2
deponent(s) or with the adoption of said child by deponent(s).
[Specify source, amount, form and purpose of each payment requested or received. If none, so state.]
/
*(Adoptive)(Birth)(Legal)Parent: typed or printed name/signature
/
*(Adoptive)(Birth)(Legal)Parent: typed or printed name/signature
/
*Attorney if any: typed or printed name/signature
*Attorney's Address and Telephone number
Sworn to before me this
day of
, .
______________
Judge of the Court
Footnotes
*Delete inapplicable provisions
22 CRR-NY D IV B Form 9-A
Current through May 31, 2021
| End of Document |
IMPORTANT NOTE REGARDING CONTENT CURRENCY: The "Current through" date indicated immediately above is the date of the most recently produced official NYCRR supplement covering this rule section. For later updates to this section, if any, please: consult editions of the NYS Register published after this date; or contact the NYS Department of State Division of Administrative Rules at [email protected]. See Help for additional information on the currency of this unofficial version of NYS Rules.