22 CRR-NY D IV B Form 23NY-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 23
22 CRR-NY D IV B Form 23
23 Affidavit and report (disinterested person certification proceeding) (private placement)
D.R.L. §§ 115, 115-d
Form 23
(Certification
as Qualified
Adoptive Parent)
9/99
FAMILY COURT OF THE STATE OF NEW YORK
COUNTY OF
________________
In the Matter of the Adoption of
A Child Whose First Name Is
(Docket)(File) No.
AFFIDAVIT and
REPORT (Disinterested
Person-Certification
by
Proceeding)
Adoptive Parent
(Private-Placement)
________________
State of New York
)
: ss.
County of
)
being duly sworn deposes and says that:
1. (He)(She) is a disinterested person as such person is defined in section 115-d of the Domestic Relations Law in that: and has no interest in the outcome of the application of the part(y)(ies) herein for certification as qualified adoptive parent(s);
2. The following fee(s) (have been) (will be) paid to deponent for services rendered in connection with the pre-placement investigation performed in connection with this certification proceeding:
;
3. The following is deponent's report of (his)(her) investigation into the truth and accuracy of the allegations set forth in the petition of
, as qualified adoptive parents in the proceeding for certification and (deponent's investigation of the various factors relevant to the suitability of the petitioners as qualified adoptive parents:
Form 23 page 2
(a) Date, place and duration of personal interview and visit at petitioners home:
(b) Report:
(c) other facts relating to familial, social, religious, emotional and financial circumstances of petitioners relevant to certification as a qualified adoptive parent(s).
Dated:
Affiant (Disinterested Person)
Print or type name
Sworn to before me
this
day
of
, .
Notary Public
22 CRR-NY D IV B Form 23
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.