ADOPTION INFORMATION FORM (Read Information …

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COMMONWEALTH OF KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES REGISTRAR OF VITAL STATISTICS ADOPTION INFORMATION form ( read INFORMATION Below Before Completing) A. INFORMATION REGARDING ORIGINAL STATUS OF CHILD Original Name of Child ________________________________________ ____ State File No. ________________ Sex ______________________________________ Date of Birth _______________________________________ Place of Birth ________________________________________ ________________________________________ _ (City) (County) (State) Name of Father ________________________________________ ________________ Race _________________ Maiden Name of Mother ________________________________________ _________ Race _________________ B.

(4) Not later than the fifteenth day of each calendar month or more frequently, the clerk of the court shall forward to the state registrar reports of decrees of adoption, annulments of adoption, and amendments of decrees of adoption which were entered in the preceding month, together with such related reports as the state registrar will require.

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