Instructions
Clear Form
THE STATE OF NEW HAMPSHIRE
JUDICIAL BRANCH
http://www.courts.state.nh.us
Court Name: Case Name: Case Number:
(if known)
INTERSTATE ADOPTION
PUTATIVE FATHER REGISTRY INFORMATION
1. Petitioner name(s) 2. Child's birthplace (city/town and state) 3. Is there a putative father's registry in the child's birth state? Yes No
4. If question #3 above is answered yes, please complete the following information and attach the appropriate fees or other requirements in order for the court to process the search request in the other state: Registry or agency name Mailing address Telephone number
5. If question #3 above is answered no, please list the steps you have taken to determine if a registry exists.
Date
Petitioner Signature
Date
Petitioner Signature
State of This instrument was acknowledged before me on My Commission Expires Affix Seal, if any
, County of by
Signature of Notarial Officer / Title
NHJB-2190-FP (10/01/2006) (formerly AOC-082J-003)
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