Government of Ontario

Application for a Copy of an Adoption Order

(THIS SPACE RESERVED FOR OFFICE USE ONLY)

BRI  _____________    CID   _____________


If you have any questions, please contact:
ServiceOntario
Toll-free: 1 800 461-2156 or
Toronto: 416 325-8305

Important:

PART A: Applicant Information

Applicant Name










Sex


Mailing Address


















Daytime Telephone Number

(

Can a message be left for you at this number?

Alternate Telephone Number

(

Additional Information About the Applicant
Please confirm that you are (check only one box)

PART B: Information About the Adopted Person AFTER Adoption






Sex



Has the person named above had a legal name change after adoption?

If "Yes" provide details below






Place of Birth of Adopted Person






Adoptive Parent "A"








Adoptive Parent "B"








PART C: Information About the Adopted Person PRIOR to Adoption (If Known)

Adopted Person






Sex



Place of Birth of Adopted Person






Birth Mother










Place of Birth






Birth Father










Place of Birth






PART D: Signed Statement by the Applicant

I hereby certify that the information I have provided on this application form is true and correct to the best of my knowledge and belief.


Mail your completed application to:

Custodian of Adoption Information
P.O. Box 654
77 Wellesley St. West
Toronto ON  M7A 1N3

The information provided on this form is collected and will be used to determine your entitlement to receive a copy of an Adoption Order with any information that may reveal the identity of a birth parent removed section 21.1 of O.Reg. 464/07 made under the Child and Family Services Act. If you have any questions about the collection of information, please contact: Director, ServiceOntario Call Centre, Contact Centre Service Branch, 5775 Yonge St, Toronto, Ontario  M3M 3E6 or call 1 800 461-2156 / 416 325-8305.

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