All information on an adoption shall be completed on a form prescribed by the division, in accordance with RSA 170-B:22. A parent or the court shall provide the following information in order to complete the form:
I. The child's information taken from a certified copy of the adoptee's original birth record, including the name of the child; the child's date and place of birth; the child's sex; the child's race; and the child's ancestry.
II. Facts about the child's birth, including:
(a)Whether there are siblings in substitute care, indicated as yes or no.
(b)Whether there are members of the sibling group adopted together, indicated as yes or no.
(c)Whether the child had a previous adoptive placement, indicated as yes or no.
(d)Whether the child is considered by the court to have special
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All information on an adoption shall be completed on a form prescribed by the division, in accordance with RSA 170-B:22. A parent or the court shall provide the following information in order to complete the form:
I. The child's information taken from a certified copy of the adoptee's original birth record, including the name of the child; the child's date and place of birth; the child's sex; the child's race; and the child's ancestry.
II. Facts about the child's birth, including:
(a) Whether there are siblings in substitute care, indicated as yes or no.
(b) Whether there are members of the sibling group adopted together, indicated as yes or no.
(c) Whether the child had a previous adoptive placement, indicated as yes or no.
(d) Whether the child is considered by the court to have special needs, such as a developmental or intellectual disability, learning disabilities, or a medical condition, indicated as yes or no.
(e) The date of adoptive placement.
(f) Sponsorship of adoption indicated as public, private or tribal, agency, independent person or other.
(g) Location of any sponsor of the adoption.
III. The natural father's information, including his full name if stated on the original birth record; his date of birth; his race and ancestry; his marital status; and whether his parental rights were terminated.
IV. The birth mother's information, including her full maiden name; her date of birth; her race and ancestry; her marital status at birth of child; and whether her parental rights were terminated.
V. Information from both adoptive parents, if a couple is adopting, or one parent in the case where one parent is adopting, including his or her full name; date and state of birth; race and ancestry; marital status; residence at the time of the child's birth; and any prior relationship with the child.
VI. The names as they shall appear on the new birth record, including the adoptive parents' names, and the adoptee's name.
VII. The current mailing address and signature of the adoptive parent or parents.
VIII. The probate court information, including the date of the adoption decree; the name, county and state of the court and the name of the judge or justice presiding; the volume, page, and record number of the probate court filing; the signature and seal of the court and date signed; and the name of the city or town of birth and the date the report was sent by the probate court to the clerk of the town or city of birth occurrence, the department of health and human services, and the division.
IX. The city or town clerk information, including the date received by the clerk of the town or city of birth occurrence; the date the new birth record was made; the signature of the clerk of the town or city; and the city or town of the clerk.