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I am (Please select one)  _ Adoptee Birth Parent Concerned Citizen Birth Family Relative Adopted Family Member *

If you are an adoptee, adopted parent, birthparent or member of the birth family, etc - Was  the adoption or birth of the adoptee in Ky?   _ Yes No Unk N/A

Are you registered to vote? _ Yes Registered in Ky Registered to Vote - Not in Ky Not a Registered Voter * Select one

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