Form PPS0330 "Adult Adoptee Requesting Copy of Adoption Record and/or Search for Birth Parent(S)" - Kansas

What Is Form PPS0330?

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

Form Details:

  • Released on July 1, 2015;
  • The latest edition provided by the Kansas Department for Children and Families;
  • Easy to use and ready to print;
  • Available in Spanish;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form PPS0330 by clicking the link below or browse more documents and templates provided by the Kansas Department for Children and Families.

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Download Form PPS0330 "Adult Adoptee Requesting Copy of Adoption Record and/or Search for Birth Parent(S)" - Kansas

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Return to: DCF/Prevention and Protection Services
PPS 0330
th
555 S. Kansas Ave 4
Floor
Rev. 7/15
Topeka, KS 66603
Page 1 of 3
(785) 296-4653
ADULT ADOPTEE REQUESTING COPY OF ADOPTION RECORD
AND/OR SEARCH FOR BIRTH PARENT(S)
Your
Your Current Name:
Telephone:
Your Street Address:
Your City/State/Zip:
Your Birth Name,
if known:
Your Date of Birth:
Name of Your Adoptive
Your Birthplace:
Parents:
Name of Your Birth Mother at time of severance or relinquishment, if known:
Name of Your Birth Father at time of severance or relinquishment, if known:
Name of Agency or person involved in your adoption, if known :
Please mark only the request(s) that apply:
I am requesting a copy of my adoption record
I am requesting a search to be conducted for my birth mother and/or father.
You must indicate which birth parent(s) you wish to have contact with by checking the appropriate person(s) below:
Your Birth Mother’s Name
(if known):
Your Birth Father’s Name
(if known):
WE DO NOT CONDUCT SEARCHES FOR GRANDPARENTS, AUNTS, UNCLES, COUSINS, etc.)
(Our agency will search for birth sibling(s) only if the adoptee and birth siblings had an established relationship prior to being adopted. If
interested, please contact our office to complete a sibling search request form.)
IMPORTANT!! If you have requested contact with your birth mother and/or father, you must complete the Authorization to Release
Information form, which must be signed before a notary.
IF YOU HAVE REQUESTED A COPY OF YOUR ADOPTION RECORD:
Within 4 - 6 weeks, you should receive a copy of your adoption record which may include a social history regarding your birth family, medical
history, pictures, and correspondence from birth family. You must be 18 years of age before any information can be released. Proof of
identity is required: a copy of your driver’s license or copy of your birth certificate is recommended. If a private agency was involved in
your adoption (i.e. Kansas Children’s Service League, Lutheran Social Services, Catholic Social Services, etc.) you may need to contact that
agency for a more complete copy of your adoption record.
IF YOU HAVE REQUESTED A SEARCH FOR YOUR BIRTH PARENT(S):
Our agency will attempt to locate your birth mother and/or father and determine whether they are interested in having contact. The search process
may take several months to complete. Please keep in mind there is a possibility our agency will be unable to locate these persons or they may not
be interested in contact. In either event, your search request will be maintained in your adoption record and be available to them should they
inquire at a future date. Upon completion, you will be notified of the search results.
You must return: (1) this completed form, (2) the notarized authorization form (if requesting a search) and (3) proper proof of
identification (a copy of your birth certificate or current driver’s license) to the address listed above.
INCOMPLETE REQUESTS WILL NOT BE PROCESSED.
Signature of Adoptee Requesting Record/Search
Date
Return to: DCF/Prevention and Protection Services
PPS 0330
th
555 S. Kansas Ave 4
Floor
Rev. 7/15
Topeka, KS 66603
Page 1 of 3
(785) 296-4653
ADULT ADOPTEE REQUESTING COPY OF ADOPTION RECORD
AND/OR SEARCH FOR BIRTH PARENT(S)
Your
Your Current Name:
Telephone:
Your Street Address:
Your City/State/Zip:
Your Birth Name,
if known:
Your Date of Birth:
Name of Your Adoptive
Your Birthplace:
Parents:
Name of Your Birth Mother at time of severance or relinquishment, if known:
Name of Your Birth Father at time of severance or relinquishment, if known:
Name of Agency or person involved in your adoption, if known :
Please mark only the request(s) that apply:
I am requesting a copy of my adoption record
I am requesting a search to be conducted for my birth mother and/or father.
You must indicate which birth parent(s) you wish to have contact with by checking the appropriate person(s) below:
Your Birth Mother’s Name
(if known):
Your Birth Father’s Name
(if known):
WE DO NOT CONDUCT SEARCHES FOR GRANDPARENTS, AUNTS, UNCLES, COUSINS, etc.)
(Our agency will search for birth sibling(s) only if the adoptee and birth siblings had an established relationship prior to being adopted. If
interested, please contact our office to complete a sibling search request form.)
IMPORTANT!! If you have requested contact with your birth mother and/or father, you must complete the Authorization to Release
Information form, which must be signed before a notary.
IF YOU HAVE REQUESTED A COPY OF YOUR ADOPTION RECORD:
Within 4 - 6 weeks, you should receive a copy of your adoption record which may include a social history regarding your birth family, medical
history, pictures, and correspondence from birth family. You must be 18 years of age before any information can be released. Proof of
identity is required: a copy of your driver’s license or copy of your birth certificate is recommended. If a private agency was involved in
your adoption (i.e. Kansas Children’s Service League, Lutheran Social Services, Catholic Social Services, etc.) you may need to contact that
agency for a more complete copy of your adoption record.
IF YOU HAVE REQUESTED A SEARCH FOR YOUR BIRTH PARENT(S):
Our agency will attempt to locate your birth mother and/or father and determine whether they are interested in having contact. The search process
may take several months to complete. Please keep in mind there is a possibility our agency will be unable to locate these persons or they may not
be interested in contact. In either event, your search request will be maintained in your adoption record and be available to them should they
inquire at a future date. Upon completion, you will be notified of the search results.
You must return: (1) this completed form, (2) the notarized authorization form (if requesting a search) and (3) proper proof of
identification (a copy of your birth certificate or current driver’s license) to the address listed above.
INCOMPLETE REQUESTS WILL NOT BE PROCESSED.
Signature of Adoptee Requesting Record/Search
Date
Return to: DCF/Prevention and Protection Services
PPS 0330
th
555 S. Kansas Ave 4
Floor
Rev. 7/15
Topeka, KS 66603
Page 2 of 3
(785) 296-4653
AUTHORIZATION TO RELEASE INFORMATION FORM
I hereby give my permission to the Kansas Department for Children and Families to release the information I have provided in the gray
shaded box below to the following person(s) for whom I have requested a search:
Their name, (if known or as last known)
Their relationship to you
Their name, (if known or as last known)
Their relationship to you
Their name, (if known or as last known)
Their relationship to you
The information in the gray shaded box below is the information our agency will provide to the person(s) you requested to be located. You must
put information in the gray shaded box below. **Please Note: In the event you do not wish to release your identifying information (name,
address, email address and/or telephone numbers), do not provide this information in the box.
Your current name:
Your telephone number:
Your cell phone number:
Your Address:
Your email address:
Your City, State, Zip
Information I wish to share to the person I requested to be located:
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
________________________________________________________________________
(You must sign your name)
Signature of Person Authorizing Release of Identifying Information
(You must sign your name in front of)
ACKNOWLEDGMENT BEFORE NOTARIAL OFFICER
State of
) (County) of
)
Signed or attested before me on this
day of
_____, 20_______
by
____________.
(Person authorizing release of above info)
Signature of Notary
Title
(Seal)
My appointment Expires:
Return to: DCF/Prevention and Protection Services
PPS 0330
th
555 S. Kansas Ave 4
Floor
Rev. 7/15
Topeka, KS 66603
Page 3 of 3
(785) 296-4653
Page of 3