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Notice Of Adoption And Medical History 17-5 - Nebraska
| Notice Of Adoption And Medical History Form. This is a Nebraska form and can be used in Adoptions County Court-Separate Juvenile Court Statewide . |
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STATE OF NEBRASKA FORM NO. 17:5 1/91 NEW NOTICE OF ADOPTION CASE NUMBER Sec. 43-107 MEDICAL HISTORY IN THE ________________ COURT OF _____________________________COUNTY, NEBR ASKA In the Matter of the Adoption of NOTICE OF ADOPTION MEDICAL HISTORY _________________________________________, Notice to: Bureau of Vital Statistics P. O. Box 95007 Lincoln, Nebraska 68509-5007 You are advised that on __________________, ______ I hav e determined that in the adoption of _______________________________________________: (new adoptive name) The medical history of the biological father is unavailable. The medical history of the biological mother is unavailable. This is a step-parent adoption; the court has dete rmined that a medical history is not required in this case. ____________________________________________________________ __________ ____________________________________________________________ __________ ______________________________________________________________________ ______________________________________________________________________ ____________________________________________________________ __________ DATE: B Y THE COURT: ( Seal) ( Clerk)
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