Missouri DHSS - Vital Records Applications and Forms · Missouri state form
Adoptee Contact Preference Form 580-3230
Form 580-3230 lets an adoptee state a preference about contact with a birth parent and provide identifying and contact information to Missouri Vital Records.
- What this form is
- Use Form 580-3230 to indicate whether you prefer no contact, contact through an intermediary, or direct contact with a birth parent. The form requests identifying information to help the Bureau of Vital Records locate the adoptee’s original birth certificate. The cover sheet says a non-refundable $15 fee must accompany the form, and it includes a sworn declaration and notary section.
- Who needs it
- An adoptee completing a contact preference and providing information to the Bureau of Vital Records about an original birth certificate.
- Why it needs a notary
- The cover sheet includes a subscribed-and-sworn jurat and notary section. The signature must be notarized; this can be done online with a commissioned online notary.
- How to submit it
- Mail the completed form with a check or money order payable to the Missouri Department of Health and Senior Services to the Bureau of Vital Records, P.O. Box 570, Jefferson City, MO 65102-0570.
Questions
What does Form 580-3230 do?
It lets an adoptee indicate a preference about contact with a birth parent: no contact, contact through an intermediary, or direct contact. It also requests information to help identify the adoptee’s original birth certificate.
Does Form 580-3230 need to be notarized?
Yes. The cover sheet contains a declaration that is subscribed and sworn before a notary, along with a notary section. You can have the signature notarized online with a commissioned online notary.
How do I submit Form 580-3230?
Mail the completed form with a check or money order payable to the Missouri Department of Health and Senior Services to the Bureau of Vital Records, P.O. Box 570, Jefferson City, MO 65102-0570. The cover sheet states that a non-refundable $15 fee must accompany it.