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Get Ma R-109 2016-2026

-CERTIFIED RECORD OF BIRTH PRIOR TO ADOPTION (Please print legibly.) Completed_________ #_________________ Cert #_____________ Initials_____________ Please fill out and return this form to the address above. If you are requesting a record by mail, make your check or money order payable to the Commonwealth of Massachusetts and include $32.00 for each copy requested. DO NOT SEND CASH THROUGH THE MAIL. Records requested in-person at the Registry counter are $20.00 per copy. Checks, money orders.

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How to fill out the MA R-109 online

Filling out the MA R-109 form online is an important step for individuals seeking a non-certified record of birth prior to adoption. This guide provides clear, step-by-step instructions to facilitate the process and ensure accuracy.

Follow the steps to complete the MA R-109 form online:

  1. Press the ‘Get Form’ button to access the form and open it in the document editor.
  2. Fill in the 'Subject of the record (Adoptee)' section, including the full name on the current birth record, date of birth, full names of adoptive parents, and city of birth.
  3. Input your personal details in the 'Person making request' section, providing your full legal name, relationship to the adoptee, telephone numbers, and mailing address.
  4. In the 'Affidavit of applicant' section, ensure to sign and date the form. If applying by mail, this must be done in the presence of a notary.
  5. Next, check the 'Identification and supplemental documentation' section. Gather necessary identification documents if applying in person, or prepare photocopies if applying by mail.
  6. If required, prepare the additional documentation, such as proof of name change or proof of relationship as specified in the form.
  7. Review all the information entered to confirm its accuracy. After verification, you can either save your changes, download the form, print it, or share it as needed.

Complete your MA R-109 form online today for a smooth and efficient process.

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