Form #2103 Rev. 05/2011 Submit to: SECRETARY OF STATE Authentications Unit P O Box 13550 Austin, TX 78711-3550 512-463-5705 Document Fee: $10 (up to $100 per child) FOR USE IN PROCEEDINGS RELATING TO THE ADOPTION OF ONE OR MORE CHILDREN REQUEST FOR OFFICIAL CERTIFICATE OR APOSTILLE-- ADOPTION PROCEEDINGS Requesting Family Name: Address: Street City State Zip Phone: Email Address: Have you made a prior authentication request for use in the same adoption proceedings? Yes No If YES, Customer ID Number: Number of Children Adopting: Name(s): Consulate/Embassy/Country Where Document(s) Will Be Presented: For Certified Records Type of Record: For Notarized Documents Name of Notary: Date Commission Expires: Number of Certificates/Apostilles Requested: Execution I certify that the requested authentication(s) is(are) for use in adoption proceedings for one or more children. Date: Signature of Requestor Instructions · Fee. The fee for an official certificate or apostille for use in a proceeding relating to the adoption of one or more children is $10 per certificate or apostille up to $100 per child. Fees may be paid by personal checks, money orders, LegalEase debit cards or American Express, Discover, MasterCard, and Visa credit cards. Checks or money orders must be payable through a U.S. bank or financial institution and made payable to the secretary of state. If paying by credit card, fees are subject to a statutorily authorized convenience fee of 2.7 percent of the total fees, and Form 2101 must also be included. · Multiple Requests. When requesting two or more certificates or apostilles, remit one payment for the total amount. You must complete a separate form for each public official or notary public. · Materials and Return of Documents. The complete, original, certified record or notarized document to be authenticated must be submitted with this form. If the authentication request concerns a translation, the complete document includes both the notarized translation and the document being translated. The document, fees, and form must be submitted with an appropriately sized self-addressed, postage pre-paid envelope for return of documents. · Delivery. Materials may be delivered by mail to P.O. Box 13550, Austin, Texas 78711-3550 or by overnight mail or hand delivery to Room 105, James Earl Rudder Office Building, 1019 Brazos, Austin, Texas 78701. Hand-delivered documents are accepted weekdays between the hours of 8:00 a.m. and 4:30 p.m. Form 2103 American LegalNet, Inc. www.FormsWorkFlow.com