ND DEPARTMENT OF HUMAN SERVICES
CHILDREN AND FAMILY SERVICES/ADOPTION
SFN 946 (Rev. 08/2005)
I will want personal contact with my adult birth child.
I understand that the law currently provides that I shall be contacted regarding a request for information by my
adult birth child who I placed for adoption. I also understand that it is my responsibility to update the agency with
my new contact information if there are any changes.
Social Security Number
I will not permit contact by a child-placing ageny on behalf of my adult birth child to secure
nonidentifying information not contained in the agency file.
Signature of Birth Parent
I will permit contact by a child-licensing agency on behalf of my adult birth child to secure nonidentifying
information not contained in the agency file.
Name of Licensed Child Placing Agency
I will not want personal contact with my adult birth child.
Name (Last, First, MI)
Your birth child that you have placed for adoption may, as an adult, want a personal contact with you. The
purpose of this Affidavit is for you to indicate at this time whether you will want this contact.
My commission expires
This affidavit was signed before me on this