ADOPT-330 Request for Appointment of 

Confidential Intermediary 

Use this form if you are seeking contact with your sibling who is not 
currently a dependent of the court and one of you has been adopted. If your 
sibling is currently a dependent of the court, you must follow the procedure 
in Welfare and Institutions Code section 388(b) instead of using this form. 

Before completing this form, you must ask for contact with your sibling from 
the department or licensed adoption agency that joined in your adoption or 
your sibling's adoption. If you do not know the name of the department or 
agency, ask the California Department of Social Services, Adoption Support 
Unit, 916-651-8088.

After filling out this form, bring it and a blank copy of the proposed Order 
(ADOPT-331) to the clerk of the court where the adoption was finalized. 
After the court signs the order, a copy of this Request and the Order will be 
forwarded to the California Department of Social Services or the adoption 
agency, as designated by the court, and copies will be given to you.

I am asking the court to appoint a confidential intermediary to help me 
get contact information for my sibling.
a.
b.
c.

My name:
My address:  
My phone number:  

Clerk stamps date here when form is filed.

Fill in court name and street address:

Superior Court of California, County of

Clerk fills in case number when form is filed.

Case Number:

2

a.

The person helping me complete this request for the appointment of a confidential intermediary is:
(1)

Name:

My attorney (State Bar No.                       )

My guardian ad litem

(2) Address:

b.

Phone number:

(3)
I do not have an attorney or guardian ad litem who is helping me complete this request for the appointment 
of a confidential intermediary.

1

3

An attorney used to represent me.
a.
Name of former attorney:
b.
Address of attorney:  
c.
Phone number of attorney:  
d.
This attorney used to represent me because:

me 
my sibling 
Name of agency:

a.
b. Address:
c.

Phone number:

4 The department or the licensed adoption agency that joined in the adoption petition for: 

Judicial Council of California, www.courtinfo.ca.gov 
New January 1, 2008, Mandatory Form
Code of Civil Procedure, § 373
Family Code, § 9205
Cal. Rules of Court, rule 5.410

Request for Appointment of 
Confidential Intermediary 

ADOPT-330, Page 1 of 2

5

6

7

8

Date:

Date:

Case Number:

Your name:

The sibling whom I would like to contact is:
a.
b.
c.

My sibling’s name:
My sibling’s current address (if known):

My sibling is under the age of 18 years. 
(1) My sibling currently lives with (name and relationship to my sibling, if known):

(1) My sibling used to live with (name and relationship to my sibling, if known):

My sibling was adopted in this county:    

Yes

No

Unknown

My sibling was previously a dependent of the court in this county:   

Yes

No

Unknown

The following are true (check all that apply):

a.

b.

c.

d.

e.

f.

I submitted a written California Department of Social Services waiver form AD 904A or AD 904B to  
 the agency listed  in  

 before I completed this form.  

4

The agency in        sent a letter to me stating that no waiver for my sibling is in its file.
A copy of the letter from the agency is attached to this request.

4

I am asking the court to appoint a confidential intermediary to help me get contact information for my sibling. 

I am under the age of 18 years.
(1)
(2) The court signed a consent giving me permission to contact my sibling:

My parent/guardian signed a consent giving me permission to contact my sibling:

Yes

Yes

No

No

My sibling is under the age of 18 years.

To the best of my knowledge, there is not now, and never has been, an order stating that I cannot have 
contact with the sibling named in      .5

9 Any other information that would be helpful to the court:

I declare under penalty of perjury under the laws of the State of California that the information in items 1 through 9, 
and in all attachments, is true and correct, which means that if I lie on this form, I am committing a crime. 

Person who helped the applicant complete the form:

Type or print your name

Sign your name 

Type or print name

Signature

New January 1, 2008

Request for Appointment of 
Confidential Intermediary 

Attorney

Guardian ad litem

ADOPT-330, Page 2 of 2