Nevada. Application For Adoption Registry - Adoptee Name _________(Last), _________(First), _________(Maiden). Date of Birth _________. Phone No. _________(Home), _________(Work). Home Address _________. Mailing Address (if different) _________. Adoptive Parents' Names _________. Agency that handled adoption (if known) _________(Name and Location). I am interested in obtaining information about my biological parent(s). I understand that I cannot receive any information unless my parent(s) also complete(s) an Application for Adoption for Registry. I understand that I may withdraw this application at any time by notifying the Adoption Registry in writing. I understand that if I withdraw my application my parent(s) will not be able to obtain information about me. Date: _________ _________ (Signature)
Subscribed and sworn to before me this _________ day of _________, _________[date]. _______________ (Notary Public) Application For Adoption Registry—Parent Name _________(Last), _________(First), _________(Maiden). Date of Birth _________. Phone No. _________(Home), _________(Work). Home Address _________. Mailing Address (if different) _________. Agency that handled adoption (if known) _________(Name and Location). Child who was adopted—Name _________, Date of Birth _________. I am interested in obtaining information about my child who was adopted. I understand that I cannot receive any information unless my child also completes an Application for Adoption Registry. I understand
that my child cannot complete the Application until he or she is eighteen years old. I understand that I may withdraw this application at any time by notifying the Adoption Registry in writing. I understand that if I withdraw my application my child will not be able to obtain information about me. Date: _________ _________ (Signature)
Subscribed and sworn to before me this _________ day of _________ _________[date]. _______________ (Notary Public) Supplemental Adoption Registry Form Name: _________ 1. To be completed by parent whose child was adopted: Child who was adopted—Place of birth _________ Where was child relinquished? _________ To what agency was child relinquished? _________(Agency Name), _________ (Agency Address). Your name at time of relinquishment _________ When was child relinquished? _________ Were your parental rights terminated by a court? — Yes — No If yes, where were rights terminated? _________(City), _________(County), _________(State). When were rights terminated? _________ 2. To be completed by adoptee: Your place of birth _________, _________[date]. Where was your adoption completed? _________ When were you adopted? _________