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Your Name
Your Address
Your Postal Code
Your Phone Number
Your E-mail address
Date:

Childrens Aid Society

Address of city/county where Adoption Finalized

RE: YOUR ADOPTIVE NAME and BIRTH DATE

Birth name if known

I am writing to request non-identifying background information about myself
and my birth family. Enclosed is a copy of my: a)drivers license; b)birth
certificate; or c)baptismal certificate

I was born on          (full date) at            (hospital if known),      
in the town/city of                              
I was adopted by              :                   
My adoptive father's full name:                  
My adoptive mother's full name:                   
When I went to live with them, the lived at:      (address if known)    
in                (town or city)                       

I understand that, under the Child & Family Services Act, I am entitled to
certain information about myself and origins. I respectfully request that
this information be forwarded to me, at the above address.

I would further request, that my name and information be submitted to the 
Adoption Disclosure Registry.
 
Thank you for your consideration.

Sincerely, 

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