IN THE PROBATE CIVIL DIVISION VVVIII T172
STATE OF INDIANA
COURT OF MARION
HONORABLE CHARLES DEITER
In the matter of:
The Adoption of YOUR MAIDEN NAME
Born on
YOUR DATE OF BIRTH
PETITION TO OPEN SEALED RECORDS
___________________________________________________________________
COMES NOW: Petition
YOUR NAME (formerly) YOUR MAIDEN NAME and hereby request this court to grant the relief requested in this petition.
Petitioner alleges as follows:
county of your birth
County, Indiana and relinquished for adoption in County of adoption took place County,Indiana. The full name of the birthfamily is unknow to Petitioner. The adoption was facilitated by the
putname of adoption agency or welfare dept.
The date of the finalization is unknown to the petitioner. OR usethe date of the finalization was if you know it
and the Names of the birthfamily is unknown to the petitioner.regarding this adoption, Including but no limited to the non-identifying information.
of the adoptee and is the best interest of the Adoptee, who is now of legal age, and that
he/she should have theopportunity to exchange information and examine records regarding
his/her birth and biological heritage.that the birthfamily has not contacted the Registry.
choice of the Courts appointment. Additionally, the welfare of the Adoptee maybe be improved through the
peace of mind which may be gained by obtaining information about the birthfamily and the adoption.
authorizing release of all sealed and confidential documents, records, files, and information containing non-
identifying and identifying information pertaining to this adoption and the birthfamily which is in the possession of
the Courts or any agency to the court appointed Confidential Intermediary for the petitioner.
Petitioner in this action requests that the Court provide for such other relief, as the court deems just and equitable under the law.
Respectfully signed and submitted this________day of __________, 1999
Name___________________________(petitioner, Pro Se)
Address_________________________
City____________________________
State & Zip______________________
Telephone_______________________
Sworn Declaration of Petitioner
I declare under penalty of perjury under the laws of the State of Indiana that the forgoing is true & correct.
Signed_______________________on_____________1999
*************************************************************IN THE PROBATE CIVIL DIVISION VVVIII T172
STATE OF INDIANA
COURT OF MARION
HONORABLE CHARLES DEITER
In the matter of:
The Adoption of Infants NAME at birth
Born on
Child’s DATE OF BIRTHPETITION TO OPEN SEALED RECORDS
___________________________________________________________________
COMES NOW:
Petition YOUR NAME (formerly) YOUR MAIDEN NAME and hereby request this court to grant the relief requested in this petition.Petitioner alleges as follows:
county of your birth
County, Indiana and relinquished for adoption in County of adoption took placeCounty, Indiana. The full name of the Adoptee is unknown to Petitioner. The adoption was facilitated by
the
put name of adoption agency or welfare dept. The date of the finalization is unknown to the petitioner.OR usethe date of the finalization was if you know it
and the Name of the Adoptee is unknown to thepetitioner.
regarding this adoption, Including but no limited to the non-identifying information.
of the Adoptee and is the best interest of the Adoptee, who is now of legal age, and that
he/she shouldhave the opportunity to exchange information and examine records regarding
his/her birth and biologicalheritage. Petitioner has provided information to the State of Indiana Adoption Registry program and
believes that the Adoptee has not contacted the Registry.
choice of the Courts . Additionally, the welfare of the Adoptee maybe be improved through the peace of
mind which may be gained by obtaining information about the birthfamily and the adoption.
Petitioner hereby request an Order from this Court authorizing release of all sealed and confidential
documents, records, files, and information containing non-identifying and identifying information pertaining
to this adoption and the birthfamily which is in the possession of the Courts or any agency to the court
appointed Confidential Intermediary for the petitioner. Petitioner in this action requests that the Court provide for
such other relief, as the court deems just and equitable under the law.
Respectfully signed and submitted this________day of __________, 1999
Name___________________________(petitioner, Pro Se)
Address_________________________
City____________________________
State & Zip______________________
Telephone_______________________
Sworn Declaration of Petitioner
I declare under penalty of perjury under the laws of the State of Indiana that the forgoing is true & correct.
Signed_______________________on_____________1999
CERTIFICATE OF SERVICE
I do hereby certify that a copy of the foregoing Petition has been duly served upon the parties listed below, by United States mail, first-class postage prepaid, on this_____day of ____________1999.
Office of Attorney General
IGC South Fifth Floor
402 W Washington St.
Indianapolis, IN 46204-2739
Burton Garten
Office of Legal Affairs
Indiana State Department of Health
2 N Meridian Street, 5B
Indianapolis, IN 46204
__________________________
pro se