Free Request for Record Information - Massachusetts

Commonwealth of Massachusetts Probate and Family Court Department
Request for Record Information
(Please note: Information required on this form is about the petitioner - not the child) (ONE RECORD REQUEST PER PETITIONER)

COURT DOCKET NUMBER: PETITIONER'S NAME: ADDRESS:

DATE REQUESTED:

DATE OF BIRTH
MONTH: DAY: YEAR:

(City/Town)

(State)

(Zip)

PLACE OF BIRTH:

SEX:

HEIGHT:

WEIGHT:

RACE:

FATHER'S NAME: MOTHER'S NAME: PETITIONER'S SOCIAL SECURITY NUMBER: MAIDEN or PREVIOUS NAME or ALIAS: REASON FOR INQUIRY REQUEST (Please check one)
Guardianship Change of Name Adoption

DATE:

(SIGNATURE)

DO NOT WRITE BELOW THIS SPACE - FOR OFFICE USE ONLY

PCF# Remarks:

RECORD

COMP.BY PHONE

PHOTOCOPY

SEALED

NO RECORD NO ADDITIONAL RECORD

(Date Processed)

(Authorized Signature)

Request for Record Information (CP-2)

c.g.f.