Form Adph-Hs 88 - Application To Prepare A New Birth Certificate After Adoption
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2APPLICATION TO PREPARE A NEW BIRTH CERTIFICATE AFTER ADOPTION
IF THE ADOPTED CHILD WAS BORN IN A FOREIGN COUNTRY, DO NOT COMPLETE THIS FORM. Contact the
Center for Health Statistics at 334.206.2644 for additional information and appropriate forms.
When a child is adopted through an Alabama court, the court forwards the order of adoption and information showing
the child’s new name and the name(s) of the new parent(s) to the Center for Health Statistics in Alabama. Upon receipt
of the information, the Center for Health Statistics will do one of the following depending upon where the child was
born:
IF THE ADOPTED CHILD WAS BORN IN ALABAMA:
The Center for Health Statistics will prepare a new birth certificate for the child showing the new names.
The fee to prepare the new certificate of birth after adoption is $25.00 which includes one certified copy of the
new record. Additional copies of the same record ordered at the same time are $6.00 each. There is an
additional fee of $15.00 to expedite a request.
IF THE ADOPTED CHILD WAS BORN IN ANOTHER STATE:
The new birth certificate for the child must be prepared in the state where the child was born.
The fee for the Center for Health Statistics to forward the order of adoption to the child’s state of birth is $10.00.
The Center for Health Statistics, upon receipt of the fee, will forward the court order of adoption and the
information showing the new names to the vital records office in the state where the child was born.
The state of birth must be contacted for a copy of the new certificate. They may require an additional fee.
Make check or money order payable to “State Board of Health.” FEES ARE NOT REFUNDABLE. Complete and
send the application below with the required documents and appropriate fee to:
Center for Health Statistics
Adoption Specialist
P.O. Box 5625
Montgomery, AL 36103-5625
If you have additional questions, call 334.206.2644. Please allow 2-4 weeks after the court action has been completed
before mailing your application and fee.
Full Name of Child After Adoption
First
Middle
Last
Date of Birth
State of Birth
County of Birth
Sex
Full Maiden Name of Adoptive Mother
First
Middle
Last
Full Name of Adoptive Father
First
Middle
Last
If Alabama Birth,
Amount
APPLICANT SECTION
Number of Copies:
Enclosed
__________
$ __________
(THIS SECTION MUST BE COMPLETED)
Anyone falsely applying for a record is subject to a penalty upon conviction of up to three months in the county jail or a fine of
up to $500. Code of Ala. 1975, § 13A-10-109. By signing, you are certifying you have a legal right to the record requested and all
of the information provided on this form is true and correct.
Signature
Date
Printed Name
Day Time Phone
Address
City
Zip
State
ADPH-HS 88/REV. 11/2012
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