Ohio Adoption Registry -- Forms


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Below are copies of the forms and instructions which are provided by the Department of Health. I apologize for the fact that on many browsers you will have to scroll left and right to read them, but that's how the Department of Health designed the forms.

Parent's form:

                            OHIO DEPARTMENT OF HEALTH         Number __________________

                            BUREAU OF VITAL STATISTICS        Date Received ___________


                                     ADOPTION

                            AUTHORIZATION FOR RELEASE



This form is prescribed for the purpose of authorizing the release of identifying information
pertaining to the biological parent of an adopted person in accordance with Section 3107.41
of the Revised Code.


                                  Type or Print Legibly


1. Present name of biological parent _____________________________________________________
                                           Last         First                Middle
2.  Date or approximate date of final decree of adoption, if known _______________________

3.  Name of biological parent at time of final decree of adoption ________________________
                                                                            Last

                      INFORMATION AS REPORTED ON ADOPTED INDEVIDUAL'S

                              ORIGINAL CERTIFICATE OF BIRTH

4. Child's name at birth _________________________________________________________________

5. Date of birth _________________________________________________________________________

6. Place of birth ________________________________________________________________________
                         City                        County                     State


I hereby authorize the Bureau of Vital Statistics, Ohio Department of Health, to release, in
accordance with Section 3107.41 of the Ohio Revised Code, identifying infonmation pertaining
to myself. I realize that the purpose of this release form is to enable the adopted person
to obtain identifying information pertaining to their biological parent.


7. Signature of the biological parent  _____________________________  Date _______________

8. Mailing address _______________________________________________________________________
                        Street Address              City              State        Zip

                                    (INSTRUCTIONS ON REVERSE)

HEA2774

                                             ADOPTION

                                    AUTHORIZATION FOR RELEASE

                                            INSTRUCTIONS


Section 3107.41 of the Revised Code provides that an adopted person 21 years of age or older may
file a petition in a probate oourt for the release of identifying information pertaining to the
adopted person's biological parents or biological sibling. Such identifying information may be
provided to the adopted person if a valid authorization for release, completed by the biological
parent or biological sibling, is on file with the Ohio Department of Health, Bureau of Vital
Statistics.

A biological parent cannot authorize the release of identifying information for the other
hiological parent.  In order for identifying information to be released for both biological
parents, each parent must complete and file an authorization for release form.  A biological
parent cannot authorize the release of identifying information pertaining to a biological
sibling of the adopted person. The biological sibling must complete and file the authorization
for release form. The biological sibling cannot authorize the release of identifying information
on the biological parents or another biological sibling.

A biological parent may request the release of additional information to the adopted person by
providing such information on a separate sheet of paper. The additional information shall be
signed, dated, and attached to the authorization for release. Such additional information
cannot pertain to the other biological parent unless the other parent has filed an authorization
for release of identifying information or to a biological sibling unless the sibling has filed
an authorization for release of identifying information.

A biological sibling may request the release of additional information to the adopted person
hy providing such information on a separate sheet of paper. The additional information shall
be signed, dated, and attached to the authorization for release.  Such additional information
cannot pertain to the biological parents or another biological sibling.

ITEM 1.  PRESENT NAME OF BIOLOGICAL PARENT - The full name of the biological parent at the
         time of completing the form.

ITEM 2.  DATE OR APPROXIMATE DATE OF FINAL DECREE OF ADOPTION, IF KNCWN - If unknown, state
         unknown.

ITEM 3.  NAME OF BIOLDGICXL PARENT AT TIME OF FINCL DECREE OF ADOPTION - Biological parent's
         surname, as it existed at the time the final decree of adoption was granted.  If
         date of final decree is unknown, this item should remain blank.

ITEM 4.  CHILD'S NAME AT BIRTH - Adopted child's complete name as reported on original
         certificate of birth completed at the time of birth.

ITEM 5.  DATE OF BIRIH - The date of the adopted person's birth.

ITEM 6.  PLACE OF BIRIH - The city, county, and state in which the adopted person was born.

ITEM 7.  SIGNATURE OF BIOLOGICAL PARENT - The legal signature of the biological parent that
         is authorizing the release of identifying data.  This item should also be completed
         with the date signed.

ITEM 8.  MAILING ADDRESS - The complete current mailing address of the biological parent
         completing the authorization for release.

The completed authorization for release form should be mailed to the
Bureau of Vital Statistics, Ohio Department of Health, P.O. Box 15098,
Columbus  Chio  43215-0098.

Sibling's form:

                            OHIO DEPARTMENT OF HEALTH         Number ___________________

                            BUREAU OF VITAL STATISTICS        Date Received ____________

                                     ADOPTION

                            AUIHORIZATION FOR RELEASE


This form is prescribed for the purpose of authorizing the release of identifying information
pertaining to the biological sibling of an adopted person in accordance with Section 3107.41
of the Revised Code.


                                   Type or Print Legibly

1. Present name of biological sibling ______________________________________________________
                                            Last                First               Middle
2. Date or approximate date of final decree of adoption, if knovn  _________________________

3.  Name of biological sibling at time of final decree of adoption _________________________
                                                                            Last

                       INFORFATION AS REPORTED ON ADOPTED INDIVIDUAL'S

                              ORIGINAL CERTIFICATE OF BIRTH

4. Child's name at birth ___________________________________________________________________

5. Date of birth ___________________________________________________________________________

6. Place of birth __________________________________________________________________________
                          City                      County                      State

I herebv authorize the Bureau of Vital Statistics, Ohio Department of Health, to release, in
accordance vith Section 3107.41 of the Ohio Revised Code, identifying information pertaining
to mvself.  I realize that the purpose of this release form is to enable the adopted person
to obtain identifying information pertaining to their biological sibling.


7. Signature of biological sibling ___________________________  Date _______________________

8. Mailing address _________________________________________________________________________
                      Street Address            City                 State           Zip


                                    (INSTRUCTIONS ON REVERSE)
HEA2780

                                             ADOPTION

                                   AUTHORIZATION FOR RELEASE

                                           INSTRUCTIONS


Section 3107.41 of the Revised Code provides that an adopted person 21 years of age or older may
file a petition in a probate court for the release of identifying information pertaining to the
adopted person's biological parents or biological sibling. Such identifying information may be
provided to the adopted person if a valid authorization for release, completed by the biological
parent or biological sibling, is on file with the Ohio Department of Health, Bureau of Vital
Statistics.

A biological parent cannot authorize the release of identifying information for the other
biological parent. In order for identifying information to be released for both biological
parents, each parent must complete and file an authorization for release form. A biological
perent cannot authorize the release of identifying information pertaining to a biological
sibling of the adopted person. The biological sibling must oomplete and file the authorization
for release form. The biological sibling cannot authorize the release of identifying information
on the biological parents or other biological siblings.

A biological parent may request the release of additional information to the adopted person by
providing such information on a separate sheet of paper. The additional information shall be
signed, dated, and attached to the authorization for release. Such additional information
cannot pertain to the other biological parent unless the other parent has filed an authorization
for release of identifying information or to a biological sibling unless the sibling has filed
an authorization for release of identifying information.

A biological sibling may request the release of additional information to the adopted person
by providing such information on a separate sheet of paper. The additional information shall
be signed, dated, and attached to the authorization for release. Such additional information
cannot pertain to the biological parents or another biological sibling.

IIEM 1.  PRESENT NUME OF BIOLOGICAI SIBLING - The full name of the biological sibling at the
         time of completing the form.

ITEM 2.  DATE OR APPROXIMATE DATE OF FINAL DECREE OF ADOPTION, IF KNCWN - If unknown, state
          unknown.

ITEM 3.  NAME OF BIOLOGICAL SIBLING AT TIME OF FINAL DECREE OF ADOPTION - Biological sibling's
         surname, as it existed at the time the final decree of adoption was granted.  If date
         of final decree is unknon, this item shoud remain blank.

ITEM 4.  CHILD'S NAME AT BIRTH - Adosted child's complete name as reported on original
         certificate of birth completed at the time of birth.

ITEM 5.  DATE OF BIRTH - The date of the adopted person's birth.

ITEM 6.  PLACE OF BIRTH - The city, county, and state in which the adopted person was born.

ITEM 7.  SIGNATURE OF BIOLOGICAL SIBLING - The legal signature of the biological sibling that
         is authorizing release of identifying data. This item should also be completed
         with the date signed.

ITEM 8.  MAILING ADDRESS - The complete current mailing address of the biological sibling
          completing the authorization for release.

The completed authorization for release form should be mailed to
Bureau of Vital Statistics, Ohio Department of Health,  P.O. Box 15098,
Columbus,  Ohio  43215-0098.


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Posted 9 Sep 2000.

Copyright 1997 by Ohio Right to Life.
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