Form DHS-1920 "Release of Information Authorization Adult Adoptee" - Michigan

What Is Form DHS-1920?

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 August 1, 2005;
  • 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 printable version of Form DHS-1920 by clicking the link below or browse more documents and templates provided by the Michigan Department of Health and Human Services.

ADVERTISEMENT
ADVERTISEMENT

Download Form DHS-1920 "Release of Information Authorization Adult Adoptee" - Michigan

Download PDF

Fill PDF online

Rate (4.5 / 5) 8 votes
RELEASE OF INFORMATION AUTHORIZATION ADULT ADOPTEE
State of Michigan – Department of Human Services
I hereby authorize the adoption agency and/or the probate court named below, in accordance
with P.A. 288 of 1939, Chapter 10, to release, upon request, my name and address to:
My Biological Parent(s)
An Adult Brother/Sister
CURRENT INFORMATION
Current Name (Last, First Middle
Birth Date
Month
Day
Year
Current Address (Street Number and Name)
Apartment Number
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
Department of Human Services (DHS) will not discriminate against any individual or group because of race, sex,
AUTHORITY:
MCLA 710.68.
religion, age, national origin, color, height, weight, marital status, political beliefs or disability. If you need help with
COMPLETION: Voluntary.
reading, writing, hearing, etc., under the Americans with Disabilities Act, you are invited to make your needs known
PENALTY:
None.
to a DHS office in your area.
Adult Adoptee’s Signature
Date
DISTRIBUTION:
1st Copy
– Probate Court that Finalized Adoption
2nd Copy – Adoption Agency
3rd Copy – Keep for Your Records
DHS-1920 (Rev. 8-05) Previous edition may be used. MS Word
1
RELEASE OF INFORMATION AUTHORIZATION ADULT ADOPTEE
State of Michigan – Department of Human Services
I hereby authorize the adoption agency and/or the probate court named below, in accordance
with P.A. 288 of 1939, Chapter 10, to release, upon request, my name and address to:
My Biological Parent(s)
An Adult Brother/Sister
CURRENT INFORMATION
Current Name (Last, First Middle
Birth Date
Month
Day
Year
Current Address (Street Number and Name)
Apartment Number
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
Department of Human Services (DHS) will not discriminate against any individual or group because of race, sex,
AUTHORITY:
MCLA 710.68.
religion, age, national origin, color, height, weight, marital status, political beliefs or disability. If you need help with
COMPLETION: Voluntary.
reading, writing, hearing, etc., under the Americans with Disabilities Act, you are invited to make your needs known
PENALTY:
None.
to a DHS office in your area.
Adult Adoptee’s Signature
Date
DISTRIBUTION:
1st Copy
– Probate Court that Finalized Adoption
2nd Copy – Adoption Agency
3rd Copy – Keep for Your Records
DHS-1920 (Rev. 8-05) Previous edition may be used. MS Word
1