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SAMPLE NON-ID LETTER (Adoptee's Version)

June 27, 2017

SAMPLE FOR NON-ID LETTER for Adoptees (Non-Identifying Information from state or adoption agency) 

 

To Whom It May Concern: 

 

My name is (your name). 

I was born on (your d.o.b) in (your town) (State). 
I was adopted at birth by (adopted moms name, maiden name), and (adopted dads name) of (city, state of adopted parents, where they lived at adoption). 


My adoption was finalized in (your county) and was handled by (agency and/or attorney). 


I want to request my full birth name and whether I was named by my birth mother or by a social worker or foster parent. I understand I may only be entitled to "as much information concerning my natural parents as will not endanger the anonymity of the natural parents." I am therefore requesting copies of all original documents with identifying info whited out. If this request cannot be honored, I then request answers to the following: Regarding my natural mother: 

 

1. Age and Date of Birth 
2. Name at time of my Birth

3. Height 
4. Weight 
5. Hair color 
6. Eye color 
7. Education 
8. Religious background 
9. Socio-Economic background 
10. Ethnic origins (for example: mother Irish/English, father Italian/German) 
11. Number and ages and sex of siblings that she had (cause of death if deceased) 12. Where she was born 
13. Where she lived at the time of my Birth 
14. Marital Status 
15. Her usual occupation 
16. Her Parents’ ages and ethnic backgrounds (for example: mother Irish/English, father Italian/German) 
17. Her parents’ educational backgrounds 
18. Her parents’ physical descriptions 
19. Her parents’ usual occupation 
20. If her parents were deceased, age & year they died and cause of death 
21. Any and all other non-identifying information (hobbies, talents, interests,etc.) 

 

 

Regarding my natural father:

1. Age and Date of Birth 
2. Name at time of my Birth 3. Height 
4. Weight 
5. Hair Color 
6. Eye color 
7. Education 
8. Religious Background 
9. Socio-Economic Background 
10.Ethnic Origins (for example: mother Irish/English, father Italian/German) 
11. Number and ages and sex of siblings he had (cause of death if deceased) 
12. Where he was born 
13. Where he lived at the time of my birth 
14. Marital Status 
15. His usual occupation 
16. His parents ages and ethnic origins (for example: mother Irish/English, father Italian/German) 
17. His parents’ educational background 
18. His parents’ physical descriptions 
19. His parents’ usual occupations 
20. If his parents were deceased, age & year they died and cause of death 
21. Any and all other non-identifying information (hobbies, talents, interests,etc.) 

 

I am hereby requesting complete medical histories on my natural mother, natural father, and their families. I am requesting that you examine my file for the purpose of determining whether or not my natural mother and/or father placed on file, a consent form granting permission to disclose the information contained in my original birth certificate or any other identifying or non-identifying information pertaining to my natural mother and/or father.

 

Thank you for your help in this matter. 

 

Sincerely, 

Your signature
Include your name and address here