Petition for Adoption Information

The following form is used for requesting the release of medical or social information that is related to an adoptee. This form cannot be used for knowing the identity of the birth parent(s). After this form is completed, it has to be signed before a deputy clerk or notary public. The original form has to be submitted to the clerk of the circuit court and a copy kept for the record. Thie form has to be either typed or printed in black ink.

Extracted Text for Proper Search

Instructions for Florida Supreme Court Approved Family Law Form 12.981(d)(1), Petition for Adoption Information 
(03/15	) 	
INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW 	
FORM 12.981(d)(1),	 	
PETITION FOR ADOPTION INFORMATION	 	
(03/15	) 	
 
 	
When should this form be used?	 	
 	
This form is used to request release of relevant medical or social information on an adoptee. You cann	ot use 	
this form to find out the identity of birth parent(s).	 	
 
This  form  should  be 	typed  or  printed  in  black  ink. 	After  completing  this  form,  you  should  sign  the  form 	
before a 	notary public	 or 	deputy clerk	. You should 	file	 the original with the 	clerk of th	e circuit court	 in the 	
county where the adoption took place and keep a copy for your records.	 	
 
 	 	 	 	
 	 	 	IMPORTANT INFORMATION REGARDING E	-FILING	 	
 
The Florida Rules of Judicial Administration now require that all petitions, pleadings, and documents be filed 
electronically  except  in  certain  circumstances. 	Self	-represented  litigants  may  file  petitions  or  other 	
pleadings or documents electronically; however, they are not required to do so. 	If you choose to file your 	
pleadings  or  other  documents  electronically,  yo	u  must  do  so  in  accordance  with  Florida  Rule  of  Judicial 	
Administration 2.525, and you must follow the procedures of the judicial circuit in which you file. 	The rules 	
and procedures should be carefully read and followed.	 	
 
 	Special notes...	 	
 
Remember, a per	son who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these 	
forms,  that  person  must  give  you  a  copy  of 	Disclosure  from  Nonlawyer	, Florida  Family  Law  Rules  of 	
Procedure Form 12.900 (a	), before he or she helps you. 	A nonlawyer h	elping you fill out these forms also 	
must	 put his or her name, address, and telephone number on the bottom of the last page of every form he 	
or she helps you complete.

Florida Supreme Court Approved F	amily Law Form 12.981(d)(1), Petition for Adoption Information 	(03/15	) 	
IN THE CIRCUIT COURT OF THE 	                    	 JUDICIAL CIRCUIT,	 	
IN AND FOR 	         	                          	 COUNTY, FLORIDA	 	
 	
 
Case No.: 	 	 	
Division: 	 	 	
IN RE: THE ADOPTION OF	 	
 
____________________________________	, 	
Adoptee(s).	 	
 
 
 	PETITION FOR ADOPTION INFORMATION	 	
 
1. 	I, {full legal name}	  	 	 	 	 	 	, am interested in this matter as:	 	
 {choose	 one	 only}	 	
       	__	adult adoptee (over 18).	 	
       	__	adoptive parent.	 	
       	__	adult birth sibling.	 	
       	__	other:	{specify}	  	. 	
 
2. 	The adoptee(s), 	{name(s)}	  	 	
was (were) born on 	{date}	  	. 	
 
3. 	I request nonidentifying information as to family medical histor	y and social history of the adoptee(s) 	
as follows:	 	
 {indicate	 all	 that apply}	 	
_____	If available, to be furnished to adoptive parents befo	re finalization of the adoption.	 	
 
_____ 	If available, to be furnished to adoptee upon request after adoptee reaches maj	ority.	 	
 
4. 	The reason I am requesting disclosure of this information is: 	 	 	
 	 	
 	. 	
 	
 
I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this 
petition  and  that  the  punishment  for  knowingly  making  a  false  statement	 includes  fines  and/or 	
imprisonment.	 	
 
Dated: 	  	 	 	 	 	 	 	
Signature of P	etitioner	 	
Printed Name: 	 	 	
Address: 	 	 	
City, State, Zip: 	 	 	
Telephone Number: 	 	 	
Fax Number: 	 	 	
 	 	 	 	 	 	Designated E	-mail Address(es): ____________________	 	
 	 	 	 	 	 	__________________________________	___________

Florida Supreme Court Approved F	amily Law Form 12.981(d)(1), Petition for Adoption Information 	(03/15	) 	
 
 
 
 
STATE OF FLORIDA	 	
COUNTY OF 	                                        	 	
 
 
Sworn to or affirmed and signed before me on 	                              	 by	: 	
 
 	
 	 	
NOTARY PUBLIC or DEPUTY CLERK	 	
 
 
 	 	
{Print,  type,  or  stamp  commissioned  name  of	 notary 	or 	
deputy clerk.}	 	
       	__	Personally known	 	
       	__	Produced identification	 	
 Type of identification produced 	                                           	 	
 
IF A NON	LAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW:	  	
[fill in 	all	 bla	nks]	 This form was prepared for the: 	{choose only one} 	(   ) adult adoptee 	 	
(   ) adoptive parent (    ) adult birth sibling (   ) other 	{sp	ecify	}______________________________.	 	
This form was completed with the assistance	 of: 	
{name of 	individual	} _________	____________________________	_______________________________	, 	
{name of business} 	______________________________________________________________________,	 	
{address} ______________________________________________________________________________	,  	
{city}	 ______	_________, 	{state}	 ______	, {zip code} __________, 	{tele	phone	 number	} __________________	.