Form DHS-1918 "Release of Information to Adult Adoptee by Brother/Sister as Proxy for Deceased Parent" - Michigan

What Is Form DHS-1918?

This is a legal form that was released by the Michigan Department of Health and Human Services - a government authority operating within Michigan. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on March 1, 2016;
  • The latest edition provided by the Michigan Department of Health and Human Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form DHS-1918 by clicking the link below or browse more documents and templates provided by the Michigan Department of Health and Human Services.

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Download Form DHS-1918 "Release of Information to Adult Adoptee by Brother/Sister as Proxy for Deceased Parent" - Michigan

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RELEASE OF INFORMATION TO ADULT ADOPTEE BY
BROTHER/SISTER AS PROXY FOR DECEASED PARENT
Michigan Department of Health and Human Services
CENTRAL ADOPTION REGISTRY
INSTRUCTIONS:
Send this original form and copy of an approved photo
A separate statement must be completed for each
identification to the Central Adoption Registry address below:
child/adoptee.
MICHIGAN DEPARTMENT OF HEALTH AND
This form MUST be accompanied by a copy of the
HUMAN SERVICES
death certificate of the deceased parent.
CENTRAL ADOPTION REGISTRY
PO BOX 30037
Send a new statement to the Central Adoption
LANSING MI 48909
Registry if your name or address changes.
I state that I am the biological
brother
sister of the child described below. Our
biological parent is deceased and the death certificate is enclosed. In accordance with Michigan
Compiled Laws Annotated 710.27, I hereby give consent to the release of our deceased parent’s
name to this child when he/she is 18 years of age or older.
A copy of an approved photo identification is included with this form. (Example: Current driver’s
license, current state issued photo identification or current student photo ID).
INFORMATION ABOUT THE CHILD:
Child’s Full Name at Birth
Child’s Birth Date (Month/Day/Year)
Child’s City of Birth
Child’s County of Birth
Child’s State of Birth
INFORMATION ABOUT DECEASED BIOLOGICAL PARENT:
Deceased Parent’s Name When Parental Rights Were Released or Terminated
INFORMATION ON BIOLOGICAL BROTHER/SISTER WHO IS CONSENTING TO RELEASE OF INFORMATION:
My Current Name
My Birth Date (Mo., Day, Yr.)
My Name at Time Parental Rights Were Terminated, If Different
Address (Street Number and Name)
Apartment or Lot Number
City
State
Zip Code
Telephone Number
Email
Brother/Sister Signature
Date
The Michigan Department of Health and Human Services (MDHHS)
AUTHORITY: MCLA 710.68.
does not discriminate against any individual or group because of
race, religion, age, national origin, color, height, weight, marital
COMPLETION: Voluntary.
status, genetic information, sex, sexual orientation, gender identity or
PENALTY: None
expression, political beliefs or disability.
DISTRIBUTION:
ORIGINAL - Michigan Department of Health & Human Services
Central Adoption Registry
PO Box 30037
Lansing, Michigan 48909
COPY
- Keep for your records.
DHS-1918 (Rev. 3-16) Previous edition may be used.
RELEASE OF INFORMATION TO ADULT ADOPTEE BY
BROTHER/SISTER AS PROXY FOR DECEASED PARENT
Michigan Department of Health and Human Services
CENTRAL ADOPTION REGISTRY
INSTRUCTIONS:
Send this original form and copy of an approved photo
A separate statement must be completed for each
identification to the Central Adoption Registry address below:
child/adoptee.
MICHIGAN DEPARTMENT OF HEALTH AND
This form MUST be accompanied by a copy of the
HUMAN SERVICES
death certificate of the deceased parent.
CENTRAL ADOPTION REGISTRY
PO BOX 30037
Send a new statement to the Central Adoption
LANSING MI 48909
Registry if your name or address changes.
I state that I am the biological
brother
sister of the child described below. Our
biological parent is deceased and the death certificate is enclosed. In accordance with Michigan
Compiled Laws Annotated 710.27, I hereby give consent to the release of our deceased parent’s
name to this child when he/she is 18 years of age or older.
A copy of an approved photo identification is included with this form. (Example: Current driver’s
license, current state issued photo identification or current student photo ID).
INFORMATION ABOUT THE CHILD:
Child’s Full Name at Birth
Child’s Birth Date (Month/Day/Year)
Child’s City of Birth
Child’s County of Birth
Child’s State of Birth
INFORMATION ABOUT DECEASED BIOLOGICAL PARENT:
Deceased Parent’s Name When Parental Rights Were Released or Terminated
INFORMATION ON BIOLOGICAL BROTHER/SISTER WHO IS CONSENTING TO RELEASE OF INFORMATION:
My Current Name
My Birth Date (Mo., Day, Yr.)
My Name at Time Parental Rights Were Terminated, If Different
Address (Street Number and Name)
Apartment or Lot Number
City
State
Zip Code
Telephone Number
Email
Brother/Sister Signature
Date
The Michigan Department of Health and Human Services (MDHHS)
AUTHORITY: MCLA 710.68.
does not discriminate against any individual or group because of
race, religion, age, national origin, color, height, weight, marital
COMPLETION: Voluntary.
status, genetic information, sex, sexual orientation, gender identity or
PENALTY: None
expression, political beliefs or disability.
DISTRIBUTION:
ORIGINAL - Michigan Department of Health & Human Services
Central Adoption Registry
PO Box 30037
Lansing, Michigan 48909
COPY
- Keep for your records.
DHS-1918 (Rev. 3-16) Previous edition may be used.