Pennsylvania Statement of Citizenship and Residency (HD01275F)
Official state formAdoptionForm HD01275FFree downloadLast verified November 10, 2026
Completed by an adoptive parent after the adoption of a foreign-born child to certify U.S. citizenship and Pennsylvania residency. The Pennsylvania court submits it to the Department of Health with the court's Certificate of Adoption of a Foreign-Born Child.
Who can use this form
- An adoptive parent of a foreign-born child
- At least one adoptive parent must complete it
- That parent must be both a U.S. citizen and a Pennsylvania resident at the time of the adoption
What to send with it
- Completed and signed statement
- Photocopy of proof of U.S. citizenship if the parent was not born in the United States or its territories, such as a U.S. passport or Certificate of Naturalization
Where to send it
- Mail to
- Pa. Department of Health Bureau of Health Statistics and Registries 555 Walnut St., 6th Floor Harrisburg, PA 17101-1934
- State fee
- Not provided
- Typical processing
- Allow up to six weeks after the adoption to hear from the office
- Form revision
- REV 09/20
- Source
- Official government page