Michigan > Local County > Oakland > Family Division
Release Of Information Authorization Adult Adoptee FIA-1920 - Michigan
| Release Of Information Authorization Adult Adoptee Form. This is a Michigan form and can be used in Family Division Oakland Local County . |
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RELEASE OF INFORMATION AUTHORIZATION ADULT ADOPTEE State of Michigan Department of Human Services I hereby authorize the adoption agency and/or the probate court name below, in accordance with P.A. 288 of 1939, Chapter 10, to release, upon request, my name and address to: My Biological Parent(s) CURRENT INFORMATION Current Name (Last, First, Middle) Birth Date Month Current Address (Street Number and Name) Apartment Number Day Year An Adult Brother/Sister City State Zip Code Telephone Number A/C ( ) ADOPTION INFORMATION Adoptive Name (Last, First, Middle) Name Before Adoption (If Known) Adoptive Mother's Name Adoptive Father's Name Birth Mother's Name Birth Father's Name Name of Probate Court Name of Placing Agency Additional Comments: The Department of Human Services will not discriminate against any individual or group because of race, sex, religion, age, national origin, color, height, weight, marital status, political beliefs or disability. If you need help with reading, writing, hearing, etc., under the Americans with Disabilities Act, you are invited to make your needs known to a DHS office in your county. DISTRIBUTION: PART 1 - Probate Court that Finalized Adoption PART 2 - Adoption Agency PART 3 - Keep for Your Records Adult Adoptee's Signature AUTHORITY: MCLA 710.68. COMPLETION: Voluntary. PENALTY: None. Date FIA-1920 (Rev.2-02) Previous edition may be used. PART 1 Probate Court that Finalized Adoption American LegalNet, Inc. www.FormsWorkflow.com RELEASE OF INFORMATION AUTHORIZATION ADULT ADOPTEE State of Michigan Department of Human Services I hereby authorize the adoption agency and/or the probate court name below, in accordance with P.A. 288 of 1939, Chapter 10, to release, upon request, my name and address to: My Biological Parent(s) CURRENT INFORMATION Current Name (Last, First, Middle) Birth Date Month Current Address (Street Number and Name) Apartment Number Day Year An Adult Brother/Sister City State Zip Code Telephone Number A/C ( ) ADOPTION INFORMATION Adoptive Name (Last, First, Middle) Name Before Adoption (If Known) Adoptive Mother's Name Adoptive Father's Name Birth Mother's Name Birth Father's Name Name of Probate Court Name of Placing Agency Additional Comments: The Department of Human Services will not discriminate against any individual or group because of race, sex, religion, age, national origin, color, height, weight, marital status, political beliefs or disability. If you need help with reading, writing, hearing, etc., under the Americans with Disabilities Act, you are invited to make your needs known to a DHS office in your county. DISTRIBUTION: PART 1 - Probate Court that Finalized Adoption PART 2 - Adoption Agency PART 3 - Keep for Your Records Adult Adoptee's Signature AUTHORITY: MCLA 710.68. COMPLETION: Voluntary. PENALTY: None. Date FIA-1920 (Rev.2-02) Previous edition may be used. PART 2 Adoption Agency American LegalNet, Inc. www.FormsWorkflow.com RELEASE OF INFORMATION AUTHORIZATION ADULT ADOPTEE State of Michigan Department of Human Services I hereby authorize the adoption agency and/or the probate court name below, in accordance with P.A. 288 of 1939, Chapter 10, to release, upon request, my name and address to: My Biological Parent(s) CURRENT INFORMATION Current Name (Last, First, Middle) Birth Date Month Current Address (Street Number and Name) Apartment Number Day Year An Adult Brother/Sister City State Zip Code Telephone Number A/C ( ) ADOPTION INFORMATION Adoptive Name (Last, First, Middle) Name Before Adoption (If Known) Adoptive Mother's Name Adoptive Father's Name Birth Mother's Name Birth Father's Name Name of Probate Court Name of Placing Agency Additional Comments: The Department of Human Services will not discriminate against any individual or group because of race, sex, religion, age, national origin, color, height, weight, marital status, political beliefs or disability. If you need help with reading, writing, hearing, etc., under the Americans with Disabilities Act, you are invited to make your needs known to a DHS office in your county. DISTRIBUTION: PART 1 - Probate Court that Finalized Adoption PART 2 - Adoption Agency PART 3 - Keep for Your Records Adult Adoptee's Signature AUTHORITY: MCLA 710.68. COMPLETION: Voluntary. PENALTY: None. Date FIA-1920 (Rev.2-02) Previous edition may be used. PART 3 Keep for Your Records American LegalNet, Inc. www.FormsWorkflow.com
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