DOH-4455New YorkFillable

Adoption Information Registry Birth Parent Registration Form

New York Family Court · Family Law

Copy of the court's form from nycourts.gov, taken October 21, 2026. See it on the court's site ↗

New York State Department of Health form for a birth parent who consented to an adoption or surrendered a child to register with the Adoption Information Registry, signed before a notary.

This form has fillable fields — you can complete it directly in the viewer on the right.
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