Department of HealthVital StatisticsAdoptee Birth Parent 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin with Part 1, Adoptee’s Information. Fill in the adoptee's first, middle, and last names as they were before adoption. Include the date and place of birth, as well as the sex of the adoptee.
3. Next, provide details for both birth parents. Enter their first, middle, and last (maiden) names accurately to ensure proper record amendment.
4. Move to Part 2 for Adoptive Parents’ Information. Clearly indicate whether you are an adoptive or biological parent by checking the appropriate box. Fill in your full name, date of birth, place of birth, current occupation (not employer), and social security number.
5. Complete your current mailing address and residence at the time of the adoptee’s birth. Ensure all fields are filled without initials to avoid delays.
6. In Part 3, leave space for the court clerk’s certification after submitting your information.
7. Finally, in Part 4, specify where you want the new birth certificate mailed. Double-check all entries for accuracy before submission.

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