Request For Non-Identifying Adoption Information Form - Skagit County, Washington

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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 a money order or cashier’s
check made payable to the Skagit County Clerk and enclose copy of your driver’s license. No
personal checks are accepted.
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. 2/03/2016)

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