Commonwealth of Massachusetts Probate and Family Court Department Request for Record Information (Please note: Information required on this form is about the petitioner - not the child) (ONE RECORD REQUEST PER PETITIONER) COURT DOCKET NUMBER: PETITIONER'S NAME: ADDRESS: DATE REQUESTED: DATE OF BIRTH MONTH: DAY: YEAR: (City/Town) (State) (Zip) PLACE OF BIRTH: SEX: HEIGHT: WEIGHT: RACE: FATHER'S NAME: MOTHER'S NAME: PETITIONER'S SOCIAL SECURITY NUMBER: MAIDEN or PREVIOUS NAME or ALIAS: REASON FOR INQUIRY REQUEST (Please check one) Guardianship Change of Name Adoption DATE: (SIGNATURE) DO NOT WRITE BELOW THIS SPACE - FOR OFFICE USE ONLY PCF# Remarks: RECORD COMP.BY PHONE PHOTOCOPY SEALED NO RECORD NO ADDITIONAL RECORD (Date Processed) (Authorized Signature) Request for Record Information (CP-2) American LegalNet, Inc. www.FormsWorkFlow.com c.g.f.