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Kansas Report Of Adoption Template

The Kansas Report of Adoption form is a vital document that officially records the adoption of a child in the state of Kansas. This form serves as a means to amend the child's birth record, reflecting their new name and the identities of their adoptive parents. Completing this form is an important step in the adoption process, ensuring that all legal records accurately represent the new family structure.

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The Kansas Report of Adoption form is a crucial document in the adoption process, serving to update the child's legal identity and ensure accurate record-keeping. This form captures essential information about the adopted child, including their new name, and details about the adoptive parents. Parents must provide their names, birth dates, and social security numbers, along with the child’s original name and birth details. The form also asks whether the child was born in a foreign country and if the adoption occurred there. It is important to select the type of adoption, such as step-parent or traditional adoption, to clarify the legal context. A designated attorney's information is required, ensuring that all legal aspects are handled properly. The completed form is submitted to the Kansas Office of Vital Statistics, which will create a new birth certificate reflecting the adoption. This process is not just a formality; it protects the rights of the child and the adoptive parents. Timely and accurate completion of this form is essential, as it helps to ensure that the child’s new identity is recognized and respected. The information provided becomes part of a permanent record, sealed to protect privacy, and can only be accessed under specific legal conditions. Therefore, understanding and properly filling out this form is vital for all parties involved in the adoption process.

Kansas Report Of Adoption - Usage Instruction

After completing the Kansas Report of Adoption form, the next steps involve submitting it to the appropriate authorities. This process ensures that the adoption is officially recognized and that a new birth certificate is created for the child. Make sure to double-check all entries for accuracy before sending the form.

Begin by filling in the child's name after adoption. This includes the first, middle, and last name.
Provide the mother's or parent I's current name, including first, middle, and last names.
Indicate the sex of the mother or parent I.
Fill in the last name of the mother or parent I prior to their first marriage.
Enter the birth date of the mother or parent I in MM/DD/YYYY format.
Specify the birth place of the mother or parent I (state).
Indicate the race of the mother or parent I.
Provide the social security number of the mother or parent I.
List the residence of the mother or parent I at the time of the child's birth, including street address, city, county, state, and zip code. Specify if this address is inside city limits.
Next, enter the current mailing address of the parent(s), including street address, city, county, state, and zip code. Again, indicate if this address is inside city limits.
Fill in the father’s or parent II's name, including first, middle, and last names.
Indicate the sex of the father or parent II.
Provide the last name of the father or parent II prior to their first marriage.
Enter the birth date of the father or parent II in MM/DD/YYYY format.
Specify the birth place of the father or parent II (state).
Indicate the race of the father or parent II.
Provide the social security number of the father or parent II.
Answer whether the child was born in a foreign country.
Indicate if the child was born to U.S. citizens.
State whether the adoption occurred in a foreign country.
Confirm if the adopting parents are Kansas residents.
Select the type of adoption: Step-Parent Adoption, Traditional Adoption, or Single-Parent Adoption.
Enter the name of the attorney involved in the adoption process.
Provide the attorney's email address.
Fill in the mailing address of the attorney, including street address, city, state, and zip code.
Provide the attorney's telephone number with area code.
Sign the form to certify that the information provided is true and correct to the best of your knowledge.
Fill in the child's name at birth, including first, middle, and last names.
Enter the child's birth date in MM/DD/YYYY format.
Indicate the child's sex.
Provide the child's birth certificate number if known.
Specify the child's birth place, including city, county/province, state, and country.
Fill in the mother’s or parent I's name prior to their first marriage.
Provide the father’s or parent II's name.
Leave space for the certification of the district court, including the court seal, judge's signature, date, and case number.

Dos and Don'ts

When filling out the Kansas Report of Adoption form, there are important guidelines to follow. Here’s a list of things to do and avoid:

Do type all information clearly to ensure readability.
Do provide accurate information about the child, including their name after adoption.
Do include both parents’ names, addresses, and social security numbers as required.
Do answer all questions completely, even if some information is unknown.
Do check the box for the immunization registry if you wish to enroll the child.
Don’t leave any sections blank unless specifically instructed to do so.
Don’t use handwritten entries; all information must be typed.

Following these steps will help ensure that the form is filled out correctly and efficiently.

Form Properties

Fact Name	Details
Purpose of the Form	The Kansas Report of Adoption form is used to amend a child's birth record following adoption.
Governing Law	This form is governed by Kansas Statutes Annotated (KSA) 59-2104 and KSA 65-2423.
Confidentiality	The Report of Adoption and the original birth certificate are sealed and can only be accessed by court order or a written request from the adopted person, if of legal age.
Eligibility for Registration	Children born outside the U.S. can have their birth certificates registered in Kansas if adopted by Kansas residents.
Signature Requirement	Both adoptive parents must sign the form to certify that the information provided is accurate.

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Preview - Kansas Report Of Adoption Form

Report of Adoption

FORM VS-220 Revised 10-2021

INFORMATION FOR AMENDED BIRTH RECORD FOLLOWING ADOPTION

DO THE PARENTS WISH TO ENROLL THE CHILD IN

CHILD

1. CHILD'S NAME AFTER ADOPTION (First, Middle, Last)

THE IMMUNIZATION REGISTRY?

Yes

2. MOTHER'S/PARENT I PRESENT NAME (First, Middle, Last)

2a. SEX

2b. LAST NAME PRIOR TO FIRST MARRIAGE

2C. BIRTH DATE (MM/DD/YYYY)

2d. BIRTH PLACE (State)

2e. RACE

2f. SOCIAL SECURITY NUMBER

2g. RESIDENCE - At the time of the child's birth: (Street and number, City, County, State, Zip )

Inside City Limits?

Yes

3. CURRENT MAILING ADDRESS OF PARENT(S): (Street and number, City, County, State, Zip)

Inside City Limits?

PARENTS

Yes

INFORMATION

4. FATHER'S/PARENT II NAME (First, Middle, Last)

4a. SEX

4b. LAST NAME PRIOR TO FIRST MARRIAGE

FOR NEW

BIRTH

CERTIFICATE

4c. BIRTH DATE (MM/DD/YYYY)

4d. BIRTH PLACE (State)

4e. RACE

4f. SOCIAL SECURITY NUMBER

5. Was the child born in a foreign country?	Yes	No
5a. Was the child born to U.S. Citizens?	Yes	No
5b. Did the adoption occur in a foreign country?	Yes	No
5c. Are adopting parent’s Kansas residents?	Yes	No

6. TYPE OF ADOPTION (select one)

Step-Parent Adoption

Traditional Adoption

Single-Parent Adoption

7. NAME OF ATTORNEY:

7a. EMAIL ADDRESS

ATTORNEY	7b. MAILING ADDRESS OF ATTORNEY: (Street and number, City, State, Zip)	7c. TELEPHONE NUMBER + AREA CODE

Parent(s) Signature (I/We agree that the above information is true and correct to the best of my/our knowledge)

Parent(s)

Signature

INFORMATION FROM ORIGINAL BIRTH CERTIFICATE

8. CHILD'S NAME AT BIRTH (First, Middle, Last)
	/			/
8a. CHILD'S BIRTH DATE (MM/DD/YYYY)		8b. CHILD'S SEX				8c. BIRTH CERTIFICATE NUMBER (if known)
/	/		Male		Female

9.CHILD'S BIRTH PLACE: (City, County/Province, State/Country)

10.MOTHER'S/PARENT I NAME PRIOR TO FIRST MARRIAGE (First, Middle, Last)

/	/

11. FATHER'S/PARENT II NAME (First, Middle, Last)
/	/

CERTIFICATION OF DISTRICT COURT

(Place court seal here)

I hereby certify that the child identified above was adopted by the above-named parent(s) on the

	day of		,		in the District Court of		County, KS.
(day)		(month)		(year)		(county)

Case Number

Signature of District Court Judge

Date

Kansas Department of Health and Environment

Office of Vital Statistics

1000 SW Jackson Street, Suite 120, Topeka, Kansas 66612

INSTRUCTIONS

Please enter the information requested for each item. This is a permanent record. All information must be typed.

Kansas District Courts are required by state statute (KSA 59-2104) to report adoptions to the Office of Vital Statistics. If the child being adopted was born outside the state of Kansas, the report of adoption will be forwarded to the appropriate state vital statistics office by the Kansas Office of Vital Statistics.

This Report of Adoption and the original Certificate of Live Birth will be sealed and will be opened only by court order or by written request of the adopted person, if of legal age, as directed by KSA 65-2423.

KSA 65-2423 also authorizes, upon request, the registration of birth certificates in the state of Kansas for children born in foreign countries that are not United States citizens born abroad, but adopted by residents of Kansas or adopted in Kansas.

When a Report of Adoption is received, the Office of Vital Statistics contacts the attorney, or adoptive parents, to obtain one or both parents’ signatures on the supplemental birth certificate. At that time, we also request the filing fee to prepare and file the new birth record.

If this adoption is a step-parent adoption, natural parent information will be taken from the original birth certificate on file with the Office of Vital Statistics.

If any items are unknown, they may be left blank. However, information in items 8 through 10 is needed to locate the original certificate.

You may obtain copies of the new certificate by paying the current certified copy fee.

For information on fees, please visit our website at https://www.kdhe.ks.gov/1171/Amendments-Corrections or call (785) 296-1436.

➤ Kansas Report Of Adoption PDF Form

Misconceptions

Misconception 1: The Kansas Report of Adoption form is only for adoptions within the state.

This is not true. The form is applicable for both in-state and out-of-state adoptions. If a child is born outside Kansas but is adopted by Kansas residents, the report will be forwarded to the appropriate vital statistics office in the child's birth state.

Misconception 2: The information on the form is not confidential.

In reality, the Report of Adoption and the original Certificate of Live Birth are sealed records. They can only be accessed by court order or through a written request from the adopted person, provided they are of legal age.

Misconception 3: All items on the form must be filled out completely.

While it is important to provide as much information as possible, some items can be left blank if the information is unknown. However, specific details, particularly in items 8 through 10, are necessary to locate the original birth certificate.

Misconception 4: The form can be submitted without an attorney.

Although it is not mandatory to have an attorney, it is highly recommended. The attorney plays a crucial role in ensuring that the form is filled out correctly and submitted properly, as they will need to obtain signatures from the adoptive parents for the supplemental birth certificate.

Misconception 5: There are no fees associated with filing the Report of Adoption.

There is indeed a filing fee required when submitting the Report of Adoption. This fee is necessary for the preparation and filing of the new birth record. For current fee information, it is advisable to visit the Kansas Department of Health and Environment's website or contact their office directly.

Documents used along the form

When completing the Kansas Report of Adoption form, several other documents may also be required to ensure a smooth adoption process. Below are some commonly used forms and documents that complement the Report of Adoption.

Original Birth Certificate: This document provides essential details about the child's birth, including their name, date of birth, and parents' names. It is necessary for amending the child's birth record after adoption.
Durable Power of Attorney: It is vital to have the appropriate Durable Power of Attorney documentation in place to manage one's affairs should the need arise.
Adoption Decree: Issued by the court, this decree finalizes the adoption process. It includes the names of the adoptive parents and the adopted child, serving as legal proof of the adoption.
Consent to Adoption: This form is signed by the biological parents, granting permission for the adoption to proceed. It ensures that all parties are in agreement regarding the adoption.
Home Study Report: Conducted by a licensed social worker, this report assesses the adoptive family's suitability. It includes interviews, background checks, and home visits to ensure a safe environment for the child.

These documents work together with the Kansas Report of Adoption to facilitate the legal transition of the child into their new family. Ensuring all forms are complete and accurate is crucial for a successful adoption process.