Massachusetts Department of Social Services FEDERAL & CENTRAL REGISTERS OF MISSING CHILDREN SEARCH REQUEST STEP ONE: Read Instructions Massachusetts General Law, chapter 210, section 5A requires that ''in any petition for adoption the department shall submit to the court verification that the adoptee is not registered with the federal register for missing children and the central register'' If this is an adoption petition where the court has or will waive the DSS written report, the petitioner must send this completed form to the address below. DSS will send verification directly to the court where the adoption petition was filed. If the requirement of a DSS written report has not been waived, DSS will obtain verification as part of the report process. TODAY'S DATE: STEP TWO: Fill in Information CHILD'S NAME: ALTERNATIVE NAME(s): DATE OF BIRTH: SOC. SEC. # (if available): PETITIONER'S NAME & RELATIONSHIP: (If represented by counsel, write attorney's name and address.) PETITIONER'S ADDRESS: PETITIONER'S PHONE #PROBATE/FAMILY COURT, Division: Docket #STEP THREE: MAIL or FAX THIS COMPLETED FORM TO (do not duplicate by doing both - THANK YOU) Department of Social Services Permanency Planning Technician, 4th Floor 24 Farnsworth St. Boston, MA 02210 PHONE # (617) 748-2238 FAX # (617) 261-7437 FOR OFFICIAL USE ONLY I hereby certify under the pains and penalties of perjury, that the above adoptee is not registered with the Federal Register for Missing Children and the Central Register, as verified by the Criminal History Systems Board. OAS: 300 Non-DSS Cases Rev. 8/95 American LegalNet, Inc. www.FormsWorkflow.com