Fill Your Massachusetts R 109 Form

Guidelines on Filling in Massachusetts R 109

Accessing a non-certified record of birth prior to adoption in Massachusetts can provide crucial information for various purposes and help piece together family history. Following a straightforward process ensures that the Massachusetts R 109 form is accurately filled out and submitted, whether by mail or in person. The form caters to specific eligibility criteria and requires careful attention to detail to avoid processing delays. Below is a step-by-step guide to help navigate the form completion process.

• Step 1: Begin by clearly printing the requested information about the adoptee in the section titled "SUBJECT OF THE RECORD (ADOPTEE)." Include the number of copies needed, full name on the current birth record, date of birth, full names of adoptive parents, and the city/town of birth. Fill in the name on the pre-adoption birth record if known.
• Step 2: In the "PERSON MAKING REQUEST" section, input your full legal name, relationship to the adoptee (check the appropriate box), and provide your complete mailing address and telephone number(s).
• Step 3: Complete the "AFFIDAVIT OF APPLICANT" section. If submitting by mail, this part requires notarization. Sign and date the form, acknowledging the oath or affirmation under penalty of perjury.
• Step 4: If applying by mail, ensure to have your signature notarized as stated in the form. Provide the date and the notary public's details, including their commission expiration date.
• Step 5: Review the "IDENTIFICATION AND SUPPLEMENTAL DOCUMENTATION" section on the reverse of the form for specific instructions based on whether you'll be applying by mail or in person. Gather and prepare to submit or show the required identification documents and any additional documentation as noted, including proof of name change, proof of death, or proof of relationship.
• Step 6: Verify the fee required for the application process - $32.00 for mailed requests and $20.00 for in-person requests at the Registry counter. Do not send cash through the mail. Prepare a check or money order payable to the Commonwealth of Massachusetts if applying by mail.
• Step 7: Mail the completed form along with the notarized affidavit (if applicable), copies of identification and supplemental documents, and the payment to the Massachusetts Department of Public Health Registry of Vital Records and Statistics at the address provided on the form. If applying in person, bring all these items to the Registry counter.

After submitting the form, the Registry of Vital Records and Statistics will process your request. Successful applications result in the receipt of a non-certified copy of a birth record prior to adoption. This document reveals details about the adoptee's birth and original legal parent(s) at the time of birth. It's worth noting that some records may include amendments such as paternity establishment. In instances where the application cannot be processed, a refund will be provided. Remember, proper identification and documentation are crucial for a smooth process.

What is the Massachusetts R 109 form?

The Massachusetts R 109 form is an application used to request a non-certified copy of a birth record prior to adoption. This form is submitted to the Massachusetts Department of Public Health Registry of Vital Records and Statistics. It allows eligible individuals to access the original birth record of an adoptee, which includes the legal parent or parents listed at the time of birth, before any amendments made due to adoption.

Who is eligible to apply for a birth record prior to adoption using the R 109 form?

Eligibility to apply for a birth record prior to adoption includes adoptees born in Massachusetts on or before July 14, 1974, adult children (18 years or older) of a deceased adoptee born in Massachusetts on or before July 14, 1974, and the parent or guardian of a child (under 18 years of age) whose deceased parent was an adoptee born in Massachusetts on or before July 14, 1974. Additionally, the adoptive parent of a child born in Massachusetts on or after January 1, 2008, and adult adoptees born on or after January 1, 2008, are eligible.

How can one apply for a birth record using the R 109 form?

The R 109 form can be submitted either by mail or in person. Applicants must include the required identification and any required documentation, and if applying by mail, the applicant’s signature must be notarized. A fee is associated with both submission methods: $32.00 by mail and $20.00 in person.

What type of identification is required to apply?

Applicants must provide a current, government-issued photo ID. Acceptable forms of identification include a driver’s license, a state-issued ID card, or a passport. If the name on the ID differs from the name at the time of the adoptee's birth or the applicant's adoption, documentation must be provided to prove the identity of the person listed on the birth record.

What documents are required if an applicant's name has changed?

If an applicant's current name is different from the name on the record due to marriage, legal change of name, or adoption, they must provide documentation such as a certified copy of a marriage certificate or a legal change of name decree to prove the identity match.

How much does it cost to apply for a birth record prior to adoption?

The application fee is $32.00 if submitted by mail and $20.00 if submitted in person at the Registry counter. Applicants should not send cash through the mail.

What will applicants receive upon processing of the R 109 form?

Upon successfully locating the birth record prior to adoption, applicants will receive a copy of the original birth record. This will include details of the legal parent(s) at the time of the adoptee's birth. The copy is printed on security paper with a statement indicating its release under specific Massachusetts General Laws or a court order and notes that the record was amended by adoption.

What happens if the application cannot be processed?

If the Registry of Vital Records and Statistics is unable to process the application for any reason, the application and the fee will be returned to the applicant.

How can applicants contact the Registry for questions about the form or application process?

Applicants with questions about the R 109 form or the application process can contact the Registry of Vital Records and Statistics at (617) 740-2600 or by email at vital.recordsrequest@state.ma.us.

Are refunds available if the placed order is not claimed?

No refunds will be issued if a record, sent to an applicant by certified mail, is not signed for by the recipient and subsequently returned to the Registry. This policy is in place because the cost of processing the request has already been incurred.

Filling out forms, especially for important records, requires attention to detail. A small mistake can delay getting the information you need or even result in the denial of your application. When it comes to the Massachusetts R 109 form, used to apply for a non-certified copy of a birth record prior to adoption, some common errors can hinder the process. By being aware of these mistakes, applicants can improve their chances of a smooth application process.

1. Not providing complete information.

   Every section of the form is important. Leaving blanks or providing incomplete answers can result in the application being returned. Specifically, the sections asking for full names, dates of birth, and addresses need to be filled out carefully. Remember, even though you know yourself or your family, the registry needs this information to locate the correct record.

2. Forgetting to include the payment.

   It's critical that the application includes the correct fee. Payments should be made by check or money order if you're mailing your application. Include $32.00 for each copy you're requesting. If you're applying in person, the cost is $20.00 per copy, and cash is accepted, though not recommended for mailed applications. Double-check that your payment amount is correct to avoid delays.

3. Submitting incorrect or insufficient identification.

   Applicants often overlook the identification requirements stated on the form. If you're applying in person, make sure to bring one of the approved forms of photo ID. For mail applications, it's necessary to include a clear photocopy of your ID. Acceptable identification includes a current, non-expired driver’s license, state ID, or passport. If the name on your ID has changed since the birth record was issued, you'll need to provide official documentation supporting your name change.

4. Failure to notarize the application if submitting by mail.

   One of the most common oversights is not getting the affidavit of the applicant at the end of the form notarized when submitting by mail. This step is crucial for the application to be processed. A notary public must witness you signing the form, verify your identity, and then apply their notary seal. Without this, the Registry cannot verify the authenticity of your application, leading to potential delays or denials.

To ensure a successful application process for a non-certified birth record before adoption, be sure to avoid these mistakes. Filling out forms accurately, providing all necessary documentation and identification, including the correct fee, and following all notarization requirements will streamline the process, getting you the documents you need without unnecessary delay.

When handling requests involving the Massachusetts R 109 form — the Application for a Non-certified Record of Birth Prior to Adoption, it's essential to be acquainted with supplementary documents and forms that could be required throughout the process. These additional documents not only facilitate a smoother application process but also ensure compliance with legal and administrative guidelines. Let's explore a few of these crucial documents.

• Death Certificate: If the application is being made by an adult child of a deceased adoptee, a certified copy of the death certificate is necessary. This document serves as proof of the adoptee's passing and establishes the applicant's eligibility under specific criteria outlined for obtaining the adoption record.
• Marriage Certificate: In cases where there has been a name change due to marriage, a certified copy of the marriage certificate might be required. This document links the name on the current legal identification with the name at the time of adoption, proving the identity of the person making the request.
• Legal Change of Name Decree: Similar to the marriage certificate, if there has been a legal name change, a certified copy of the decree must accompany the application. This document is crucial for verifying the applicant's identity when the name on their identification does not match the name associated with the record being requested.
• Certified Copy of Birth Certificate: For those applying on behalf of their deceased parent, a certified copy of the applicant’s birth certificate is required. This establishes the relationship of the applicant to the adoptee, confirming their standing under the guidelines for record request eligibility.
• Legal Guardianship Documentation: If the application is being submitted by a legal guardian, official guardianship documents must be presented. These documents confirm the guardian's authority to act on behalf of the person named in the adoption record.
• Driver’s License or Other Government-issued Photo ID: As part of the identification requirement, a valid, non-expired photo ID (e.g., driver’s license, state ID, or passport) must be included or presented during the application process. This is for verification of the applicant's identity and to prevent fraudulent requests.

Understanding these documents' roles in the application process for a non-certified pre-adoption birth record is vital for ensuring all requirements are met efficiently. Each document serves a specific purpose, from establishing relationships to proving identity changes, thereby supporting the overall goal of obtaining the desired birth record. Navigating through these applications can be complex, but knowing what documents accompany the Massachusetts R 109 form can provide clarity and reassurance. It’s about facilitating access while maintaining the integrity and privacy of the records involved.

The Massachusetts R 109 form, used for requesting a non-certified record of birth prior to adoption, bears similarities to a few other documents related to vital records and legal document applications. Each of these documents has distinct features but serves the purpose of retrieving or amending public records.

Application for a Certified Copy of a Birth Certificate: Much like the R 109 form, applications for certified copies of birth certificates require the applicant to provide detailed personal information and proof of their identity or relationship to the person on the record. Both applications necessitate information about the birth, such as date and place, and the parents' names. However, the key difference is that the R 109 form is specifically for pre-adoption records and isn't certified, whereas applications for a birth certificate usually result in a certified document that can be used for legal identification and other official purposes.

Application for Change of Name: This document shares the necessity of detailed personal information, similar to the R 109 form. Applicants must provide their current legal name, the name they wish to change to, and reasons for the change. Both forms may require notarization and additional documentation to support the application, such as proof of identity and, in the case of the name change application, the legal basis for the change (marriage, divorce, or court order). While the R 109 form is focused on accessing historical birth records, the name change application is about legally altering one's name in the public record.

Request for Adoption Information: This form, used in many states to obtain non-identifying information about an adoption, has similarities to the R 109 form in its purpose to provide individuals with information about their origins. Both forms are designed for individuals affected by adoption, but the Request for Adoption Information form might also include details about the adoptee's biological parents, such as age and health information, without revealing identifying information. The R 109 form is more specific in providing a copy of the original birth record before adoption.

Filling out the Massachusetts R 109 form, an application for a non-certified record of birth prior to adoption, requires careful attention to detail and an understanding of the form's requirements. Below are key dos and don'ts to ensure the process goes smoothly and to improve the chances of a successful application.

• Do print legibly or type the information to prevent errors or delays caused by illegible handwriting.
• Do review the entire form before starting to fill it out to ensure you understand all the required information.
• Do include the correct fee ($32.00 for mail requests, $20.00 for in-person requests) and pay with a check or money order made payable to the Commonwealth of Massachusetts when sending by mail. Remember, cash is not accepted through the mail.
• Do attach a clear, legible photocopy of your identification if you are submitting your application by mail. Acceptable forms of ID include a valid, non-expired driver’s license, state ID, or passport.
• Do ensure your signature is notarized if you're applying by mail, as this is a requirement for processing.
• Do provide all necessary supporting documentation, such as proof of relationship or legal guardianship, if applicable.
• Do carefully check that you have filled out all required sections of the form to avoid delays.
• Do include your contact information, such as a current mailing address and phone number, so the registry can reach you if there are any questions.
• Do verify that you are eligible to apply for the record, based on the dates and relationships outlined in the application instructions.
• Do remember that if you do not sign for a record sent to you by certified mail, and it is returned to RVRS, you will not be issued a refund.

• Don't send cash through the mail. This is a safety measure to avoid loss or theft.
• Don't overlook the need for your signature to be notarized if mailing your application. An application without a notarized signature cannot be processed.
• Don't submit incomplete forms, as this will result in processing delays or the return of your application.
• Don't use a credit or debit card for payment, as these are not accepted. Ensure you're using an accepted method of payment.
• Don't forget to include a photocopy of your ID (if mailing) or present one in person. Your application cannot be processed without proper identification.
• Don't ignore the specific instructions for documentation, especially if there are name changes involved or you are applying for a record on behalf of someone else.
• Don't hesitate to contact the Registry of Vital Records and Statistics for clarification or assistance if you have questions about the application process.
• Don't leave sections of the form blank; if a section does not apply, indicate this appropriately as instructed on the form.
• Don't assume your application will be processed immediately. Allow for processing time and check with the registry if you have concerns about the status of your application.
• Don't provide false information under oath. Doing so is punishable by fine and imprisonment, as noted on the form.

Many people have misconceptions about the Massachusetts Form R 109, which is used for obtaining a non-certified record of birth prior to adoption. Understanding these misconceptions is crucial for individuals seeking this information. Here are eight common misunderstandings and clarifications:

• Only the adoptee can request their pre-adoption birth record. In reality, not only can the adoptee request their record, but also adoptive parents, adult children of deceased adoptees, and legal guardians of a child of a deceased adoptee, among others specified by state law.
• You need a court order to obtain a pre-adoption birth record. Since December 5, 2007, individuals specified by state law can apply for a pre-adoption birth record without needing a court order if the adoptee was born in Massachusetts on or before July 14, 1974, with expanded eligibility in subsequent years.
• Form R 109 applications must be submitted in person. While in-person submission is an option, applicants can also send their applications by mail, provided they include all necessary identification and documentation and their signature is notarized.
• Credit or debit cards are accepted for payment. Payment for records requested by mail must be made by check or money order payable to the Commonwealth of Massachusetts. Credit and debit cards are not accepted, though cash is accepted for in-person requests.
• The fee is the same regardless of how you apply. The application fee is $32 for requests made by mail and $20 for those made in-person at the Registry counter.
• Any form of identification is acceptable for the application. The application requires specific forms of government-issued photo ID. If applying by mail, a photocopy of the ID must be enclosed. Additional documentation may be required based on the applicant's relationship to the adoptee or changes in name.
• You will receive a certified copy of the birth record. The copy of the birth record provided is non-certified. It is printed on security paper and contains a statement specifying its release under specific sections of Massachusetts General Laws or a court order and that it was amended by adoption.
• A refund is guaranteed if the record cannot be located. While refunds are issued if the application cannot be processed, no refund is given if the mailed record is not signed for and is returned to the Registry of Vital Records and Statistics (RVRS).

Each of these clarifications is designed to help individuals seeking information about a pre-adoption birth record to understand the process, requirements, and options available to them under the Massachusetts Form R 109 application process.

Filling out the Massachusetts R 109 form, an application for a non-certified record of birth prior to adoption, is a significant step for adoptees, adoptive parents, and immediate family members seeking insight into an adoptee's origins. It's a path to obtaining valuable information held by the Massachusetts Department of Public Health Registry of Vital Records and Statistics. Understanding the form's requirements is crucial for a smooth process:

• Eligibility criteria vary over time: Adoptees born in Massachusetts on or before July 14, 1974, adult children of deceased adoptees, and parents or guardians of a child of a deceased adoptee have been eligible to apply since December 5, 2007. The eligibility expanded on January 1, 2008, to include adoptive parents of children born in the state from that date onwards. As of January 1, 2026, adult adoptees born after January 1, 2008, will also be eligible.

• Application methods offered: Applicants have a choice of submitting their application either by mail or in person. While the convenience of mailing is clear, applying in person at the Registry counter can expedite the process and reduce the application fee.

• Identification is mandatory: All applicants must present a current, government-issued photo ID. Those unable to present the IDs listed (driver’s license, state ID card, or passport) must contact the Registry for approval of alternative identification.

• Notarization is required for mail applications: For those submitting their application by mail, the application must be signed in the presence of a notary. This step adds a layer of verification to the application process, ensuring that the individual applying is indeed who they claim to be.

• Documentation to support your application is crucial: Depending on the relationship to the adoptee and any changes in names after adoption, applicants may need to provide additional documentation such as certified copies of a marriage certificate, death certificate, or legal change of name decree.

• Fees vary by application type: The application fee is $32.00 when applying by mail and $20.00 for those applying in person. This difference acknowledges the additional administrative handling for mailed applications. Importantly, all fees must be paid via check or money order when mailing the application, as cash is not accepted and the Registry does not process credit or debit card payments.

• Processing outcomes: If the search for the requested birth record predating adoption is successful, the applicant will receive a copy of the birth record, which includes the legal parent(s) listed at the time of birth. This document, printed on security paper, explicitly mentions its release under specific sections of the Massachusetts General Laws or a court order and clarifies that it is not a certified copy of a birth record.

It's important for applicants to carefully review the form and its instructions to ensure all necessary information and documentation are provided. This careful preparation can help ensure that the Registry of Vital Records and Statistics can process the request promptly and accurately.