Date: Putative Father Registry Office of Vital Statistics Department of Health, State of Florida P. O. Box 210 Jacksonville, Florida 32231-0042 RE: Certificate of Search of Florida Putative Father Registry Brevard County Case Number: _________________________ Dear Sir/Madam: A Petition for Termination of Parental Rights and Stepparent Adoption has been filed with the Court in Brevard County, Florida. Attached is a copy of the order signed by Judge __________________ requesting a search of the Putative Father Registry be conducted to verify whether a claim of Paternity has been filed. If so, please provide a certificate regarding the identity and contact information for each registered father. If no one has registered, please provide a certificate for filing with the Clerk of Court stating a diligent search of the Registry has been conducted and no matching registration has been located. Please mail the Certificate to: _________________________________________ _________________________________________________ _________________________________________________ The biological mother has named _____________________________________ as the unmarried biological father. His address is _________________________________________________________. He was born on ____________________, his physical description is ____________________________ ___________________________________________________________________________________. The biological mother is ________________________________________, her maiden name was ____________________________, she was born on ____________________, her physical description is ___________________________________________________________________________________. The biological mother states that the child was conceived on or about _____________________, in ______________________________. The child’s name is _________________________________, a/ka ____________________________, and the child was born on ___________________________, in _____________________________________________________. Sincerely, Printed Name:______________________________ Address:___________________________________ City/State/Zip:______________________________ Phone Number:_____________________________ Law 1082 - Rev. 12/2004 American LegalNet, Inc. www.USCourtForms.com