Petition For Registration Of An Adoption Order From A Foreign Country Page 6

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Petitioner, ______________________________ (name), appeared before me on the
_______ day of _________________________, 20 _____, and proved to me Petitioner’s identity
in the form of a __________________________________. After being sworn and while under
oath, Petitioner stated that Petitioner had read this document, understood the contents, and the
contents were true of Petitioner’s personal knowledge. Petitioner then signed this document in
my presence.
__________________________________
Notary Public
Petitioner’s Address:
____________________________________
____________________________________
____________________________________
8/04
3

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