Request for Court Adoption Records Name (Person Making Request) Mailing Address Telephone Number Child222s Birth Name (prior to adoption) Signature: Date: Court staff use only: ID checked: Driver222s License Other: Records released: Amount Paid $ Court staff initials: Date: Fee Code for Redaction/SegregationNo court order required. Court order required (segregation and redaction may apply) Adoptive parent Petitioner222s (Adoptive parent222s) attorney of record A representative from the Department of Human Services. The adopted person (must be 18 years of age or older ) (home study exempt from disclosure unless court orders otherwise I /my agency signed a document in the court record, and I am requesting access only to that record. (redaction required) (if biological parent, court order required if child was surrendered to DHS or parental rights were terminated ) The biological parent American LegalNet, Inc. www.FormsWorkFlow.com