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REQUEST TO PLACE A CONTACT PREFERENCE AND MEDICAL HISTORY FORM

WITH THE CHILD’S ORIGINAL BIRTH CERTIFICATE

FOR

BIRTH PARENT(S) OF ADOPTED CHILDREN BORN IN ALABAMA

Alabama law directs the State Registrar to establish a new birth certificate after an adoption takes place. The new

birth certificate is substituted for the original birth certificate in the files, and the original birth certificate and

evidence of adoption are placed in a “sealed file” that previously could only be accessed by obtaining a court order

(Section 22-9A-12). In 2000, the Alabama legislature amended the vital records law to allow a person 19 years of

age or older whose original birth certificate was placed in a “sealed file” to obtain a non-certified copy of that record

and any other documents in the “sealed file.” Therefore, the child will be able to obtain all information on the

original birth certificate including the name(s) of the parent(s) and any legal documents in the vital records file

related to the adoption.

PARENT’S PREFERENCE FOR CONTACT

The 2000 revision to the vital records law provides for a birth parent, at his/her request, to place a Contact

Preference and Medical History Form in the “sealed file.”

The completed form will be placed in an envelope which will be put into the “sealed file” with the original

birth certificate if the parent can provide sufficient information for us to locate the original birth certificate.

The Contact Preference Form is considered a private communication from the birth parent to the child and

no copies of the form will be given to anyone other than the child.

The law does not require the child to follow the preference as stated by the parent on the form.

INFORMATION NECESSARY TO LOCATE THE ORIGINAL BIRTH CERTIFICATE

We will attempt to locate the original birth certificate by checking “sealed files” for children born on a

particular day and place.

Therefore, we must have the exact day of birth and the exact city or county where the child was born

for us to locate the original birth certificate.

If we locate a possible record, we must also have the mother’s name exactly as it appears on the

original birth certificate to confirm that we have the correct record.

PROCEDURES

Complete this application and the enclosed Contact Preference and Medical History Form.

Enclose a fee of $25.00 for searching for the original birth certificate. Make checks payable to “Alabama

Vital Records.” This fee is for the search and is not refundable.

If we locate the original birth certificate, we will place the Contact Preference and Medical History form in

the “sealed file” with the original birth certificate and send you a letter stating that we did so.

If we are unable to locate the original birth certificate, we will return the Contact Preference Form to you

with a letter stating we were unable to locate the record.

Mail to:

Vital Records - Adoptions Section

P.O. Box 5625

Montgomery, Alabama 36103-5625

APPLICANT SECTION (This Section Must Be Completed)

Amount Enclosed $

I request that you place the attached Contact Preference and Medical History with the original birth certificate

of my child

and that this form be given to my child if he/she requests a copy of his/her original birth

certificate.

Your Signature

Date

Print Your Name

Phone Number

Address

City

State

ZIP

ADPH-HS-86/Rev. 10/2009

FOR ADDITIONAL INFORMATION CALL 334. 206.5426

Form Adph-Hs-86 - Request To Place A Contact Preference And Medical History Form With The Child'S Original Birth Certificate Page 2

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