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Adult adopted persons may request information by completing this form and sending it with a copy of a valid government-issued photo identification card to the following address:  

Kentucky Cabinet for Health and Family Services
275 E Main St , 3C-E
Frankfort , Ky 40621
(502) 564-2147

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Adopted name

____________________________                                  __________________________
Adopted person’s birth date                                              Social Security number  

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Adoptive parents’ names  

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County of adoptive parents’ residence at time of adoption  

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Birth parents’ names, if known  

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My current name                                                     phone          

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My  current address  

_______________________________________________________________________  

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Signature

Nature of  request:____________background info on the birth family__________________