SKAGIT COUNTY, WASHINGTON REQUEST FOR NON-IDENTIFYING ADOPTION INFORMATION Name of Requestor (Please Print)___________________________________ Phone (____)__________ Address_____________________________________________ City__________________ State______ Requestor's relationship to Adoptee (self, birth parent, adoptive parent)_________________________ RCW 26.33.340 Department, agency, and court files confidential ­ Limited disclosure of information. Department, agency, and court files regarding an adoption shall be confidential except that reasonably available non-identifying information may be disclosed upon the written request for the information from the adoptive parent, the Adoptee, or the birthparent... Identifying information may also be disclosed through the procedure described in RCW 26.33.343. There is a $30.00 statutory (RCW 36.18.016(1)) special services fee. Following judicial review your request will be processed. Non-identifying information that is available may be disclosed. If no record is found you will be notified. Please mail completed request form and fee to: Skagit County Clerk, 205 W. Kincaid St Room 103, Mount Vernon, WA 98273. Please enclose check made payable to the Skagit County Clerk and enclose copy of your driver's license. TO ASSIST THE CLERK IN LOCATING THE ADOPTION RECORD, PLEASE PROVIDE AS MUCH OF THE FOLLOWING INFORMATION AS POSSIBLE: **Please indicate if unknown** Skagit Co. Superior Ct. Case No. ___________________________ Date of adoption ________________ Name of Adoptee before adoption_________________________________________________________ Name of Adoptee after adoption (if different that above)_______________________________________ Adoptee (circle one) MALE or FEMALE Adoptee's birthdate _____________ Age when adopted _____ Birth Mother's name (at time of birth)______________________________________________________ Birth Father's name_____________________________________________________________________ Adoptive Mother's name________________________________________________________________ Adoptive Father's name_________________________________________________________________ REQUESTOR'S Signature__________________________________________ *******************************Office Use Only**************************************** Record search by: _______________________ Re-check search by: (Supervisor) __________________ Response:____________________________________________________________________________ ____________________________________________________ Date: ___________________________ Request for Non-Identifying Info. (Rev. 9-5-2000) American LegalNet, Inc. www.FormsWorkFlow.com