ADOPT-331 Order for Appointment of 
Confidential Intermediary 

Clerk stamps date here when form is filed.

COURT WILL FILL OUT SECTION BELOW

The judicial officer has read and reviewed the Request for Appointment of 
Confidential Intermediary (ADOPT-330) filed by

(Name):

asking the court to appoint a confidential intermediary. The court orders as 
follows:

Fill in court name and street address:

Superior Court of California, County of

 The request for appointment of confidential intermediary is granted.

One or both siblings are adoptees. The following is hereby appointed 
as the confidential intermediary:
a.     
b.  

California Department of Social Services
A licensed adoption agency (name of agency): 

Clerk fills in case number when form is filed.

Case Number:

The licensed adoption agency will not serve as a confidential intermediary because of economic hardship. The 
following entity or person is appointed as the alternate confidential intermediary:
a.     
b.     
c.  

Name:
Address:  
Phone number:  

  The request is denied because the court finds that granting this request would be detrimental to the adoptee or
  the sibling with whom contact is sought.

A copy of this order and the request (ADOPT-330) is to be forwarded to the person making this request.

A copy of this order and the request (ADOPT-330) is to be provided to the confidential intermediary named 
above. 

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Date:

Judge (or Judicial Officer)

IMPORTANT: A confidential intermediary must not use any information found in the records of the adoptee or 
sibling unless the use is authorized in the Family Code, section 9205(g) and rule 5.410 of the California Rules of 
Court.

Judicial Council of California, www.courtinfo.ca.gov 
New January 1, 2008, Mandatory Form
Family Code, § 9205(c)(g)(h)
Cal. Rules of Court, rule 5.410

Order for Appointment of 
Confidential Intermediary 

ADOPT-331, Page 1 of 1