Complete the form with accurate information, attach the necessary identification and a check or money order for $20 made payable to 'Vital Records'. Mail the form and documents to Department of Health, Division of Vital Records, Attn: Adoptee Applications, PO Box 1528, New Castle, PA 16103-1528. Ensure that all provided information is correct to avoid delays.

The purpose of the Adoptee's Application for Noncertified Copy of Original Birth Record is to provide a means for adopted individuals or their lineal descendants to obtain noncertified copies of their original birth records. This is authorized under Act 127 of 2016, which allows access to such records for personal, genealogical, or legal purposes. By completing this form and submitting the necessary documents, eligible individuals can obtain valuable information about their birth and heritage. This is essential for those looking to understand their biological origins, lineage, and familial history. It also assists legal representatives managing the estates or legal matters involving adopted persons. The information provided through this form can be used for a variety of personal and official needs, ensuring transparency and access to historical birth records.

• 1. Current Legal Name of Applicant: Enter your current legal name as it appears on your identification.
• 2. Street Address: Provide your current residential address.
• 3. Daytime Phone Number: Enter your contact number for any follow-up inquiries.
• 4. Email Address: Provide your email address for communication purposes.
• 5. Name on Official Birth Record: Enter the name as it appears on the official birth record post-adoption.
• 6. City of Birth: Provide the city where the adopted person was born.
• 7. Date of Birth: Enter the birth date of the adopted person.
• 8. Adoptive Mother's/Parent's Name: Provide the name of the adoptive mother or parent before their first marriage.
• 9. Adoptive Father's/Parent's Name: Provide the name of the adoptive father or parent before their first marriage.
• 10. Name on Original Birth Record: Enter the name as it appears on the original birth record pre-adoption, if known.
• 11. Birth Mother's/Parent's Name: Provide the birth mother's or parent's name before their first marriage, if known.
• 12. Birth Father's/Parent's Name: Provide the birth father's or parent's name before their first marriage, if known.

Failure to submit this form accurately and completely can lead to delays or denials in processing your request.

• Incomplete Information: Missing details may cause the form to be returned for completion.
• Invalid Identification: Providing expired or unaccepted ID can result in a rejection of the application.
• Insufficient Payment: Not including the required fee will prevent the processing of your request.

• 1. Verifying Heritage: To verify birth information and heritage of the adopted person.
• 2. Genealogical Research: To assist in conducting family history or genealogical research.
• 3. Legal Purposes: For legal representatives managing an estate or other legal matters involving an adopted person.
• 4. Personal Information: For adopted individuals seeking to know more about their biological parents and origins.