Sample Letters to Request
Non-Identifying Information
* * * MAKE SURE TO HAVE YOUR LETTER NOTARIZED * * *
You can receive Non-ID from DCYF, the court, the agency, or attorney.
Date
Name of entity
Street Address
City, state, zip code
Subject: Request for non-identifying information
your adoptive name
date of birth
place of birth date and county
approx. date/county of adoption finalization
your adoptive parents full names
Pursuant to ARS 8-106(E), ARS 8-121(D) and ARS 8-129, I hereby make this request to receive non-identifying information regarding my birth, family history, medical information, relinquishment, and adoption placement.
Please contact me directly to advise on the actual and reasonable cost of providing this information.
Regarding my birthfamily, I seek the following information on my:
birthmother, birthfather, biological birthsiblings, maternal birthgrandparents, paternal birthgrandparents
regarding:
- ethnic/racial background
- any tribal affiliation
- age at time of my birth
- state of birth
- usual residence at time of my birth
- physical desciption:
- height
- weight
- hair color and texture
- eye color
- build
- primary language
- right or left handed?
- age at onset of menstruation
- wear glasses
- educational background:
- number of years attended school
- academic performance
- favorite subjects
- hobbies
- occupation
- religious affiliation
- siblings
- ages
- sex
- complete medical background and history, including:
- AIDS
- Allergies
- Cancer
- Cerebral Palsy
- Diabetes
- Emphysema
- Epilepsy
- Eye Problems
- Heart Disease
- HIV Positive
- Kidney Disease
- Mental or Emotional Problems (DSM Diagnosis?)
- Multiple Scerosis
- Nervous Disorders
- Obesity
- Retardation
- Other
What was the reason(s) for my relinquishment?
Were my birthparents married?
If yes:
- to each other or to different spouses?
- when and where
Has any member of my birthfamily contacted your agency about me?
If yes:
- who, when and for what purpose?
- did they complete and provide a consent letter?
Thank you for your time. Please let me know the approximate costs involved in providing this information to me. And the approximate time needed to provide to me.
Sincerely,
your name
current address
city, state, zip code
telephone number
e-mail address (if desired)
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