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Putative Father Search Request Logging
System Information 
Logging Type:
  101 
Logging Item:
  0 
Create Date:
   
Requestor Information

The information provided on this form will be used to search the Kentucky Putative Father Registry and provide an affidavit of that search with a copy of any registrations supplied to the requestor. The fee for this search is $25.00 and is non-refundable. Please attach a copy of the Adoption Petition or Birth Mother Consent.


Requestor First Name:
*
Requestor Middle Name:
Requestor Last Name:
*
Agency Name (If Applicable):
State Bar Number (If Applicable):
Address:
*
Address:
City:
*
State:
*
Zip:
*
Phone:
*
Email:
*
Relationship To Child:
*
Birth Mother Information
Mother First Name:
*
Mother Middle Name:
Mother Last Name:
*
Mother's Date of Birth:
Mother Place of Birth:
Mother Place of Residence:
Mother Current Mailing Address:
 
City:
State:
Zip Code:
Child Information
Child First Name:
*
Child Middle Name:
Child Last Name:
*
Child's Date of Birth:
*
Child Place of Birth:
Child's Gender:
Requestor Agreement

By submitting this search request, I hereby state that I am entitled to receive this information as set forth in 922 KAR 1:560.


Requestor Name:
*
Date of Submission:
*

The information provided on this form will be used to search the Kentucky Putative Father Registry and provide an affidavit of that search with a copy of any registrations supplied to the requestor. The fee for this search is $25.00 and is non-refundable. Please attach a copy of the Adoption Petition or Birth Mother Consent.

For Administrative Use Only
Status:
*
 
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