STATE OF MAINE DISTRICT COURT Location Docket No. In re the Adoption of: (Name of Minor Adoptee) ADOPTION REGISTRY ACKNOWLEDGMENT 18-A M.R.S. � 9-304(e) The person signing this Acknowledgement is: 1. 2. 3. 4. Petitioner Biological Mother Biological Father Adoptee (if 18 years of age or older) I acknowledge that I have been informed of the existence of the adoption registry and the services available through the State of Maine Registrar of Vital Statistics under 22 M.R.S. � 2706-A. Dated: Petitioner/Biological Parent/Adoptee Dated: Petitioner/Biological Parent/Adoptee AD-010, Rev. 10/16 Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com