-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:
- Press the ‘Get Form’ button to access the form and open it in the document editor.
- 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.
- Input your personal details in the 'Person making request' section, providing your full legal name, relationship to the adoptee, telephone numbers, and mailing address.
- 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.
- Next, check the 'Identification and supplemental documentation' section. Gather necessary identification documents if applying in person, or prepare photocopies if applying by mail.
- If required, prepare the additional documentation, such as proof of name change or proof of relationship as specified in the form.
- 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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