Indiana Birth Parent Nonrelease (State Form 46392)
Official state formAdoptionForm State Form 46392Free downloadLast verified November 10, 2026
Completed by a birth parent to restrict the release of their identifying information for a number of years, until a set date, or permanently. It is mailed to the Adoption Matching Program at the Indiana Department of Health.
Who can use this form
- The birth parent or birth parents of an adopted child.
- The form must be signed and dated to be valid.
- If no time option is selected, the form expires upon the birth parent's death.
What to send with it
- The signed and dated form with one time option selected.
- A photocopy of a valid government, state, or military identification. The address must match the address on the form.
- Your choice of whether to receive notice 90 days before the form expires.
Where to send it
- Mail to
- Indiana Department of Health Adoption Matching Program 2 North Meridian Street Indianapolis, IN 46204
- State fee
- Not provided
- Typical processing
- Not provided
- Form revision
- R4 / 11-24
- Source
- Official government page