Petition For Registration Of An Adoption Order From A Foreign Country Page 8
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94. The fact, time, and place of birth of the minor child are as follows:
_____________________________________________________________
Sex of child: [ ] male
[ ] female
Names of biological parents (if available):
Father ___________________________________________________
Mother ___________________________________________________
Birthdate of child: ______________________________
Country of birth _________________________________________________
Location of birth (equivalent of city, county, state; or, city, ward, province; etc.)
_______________________________________________________________
ORDER
Based upon the above findings the Court orders that the Registrar for the State of Utah
prepare a birth certificate for the minor child changing the child’s name to
_____________________________________________________________________.
DATE ______________
BY THE COURT
___________________________
DISTRICT COURT JUDGE
8/04
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