Washington Birth Parent Request for Original Birth Certificate from Adoption Sealed File (DOH 422-103)
Official state formAdoptionForm DOH 422-103Free downloadLast verified November 10, 2026
A birth parent completes this form to ask for a copy of their child's birth certificate from before the adoption, kept in the sealed adoption file. It is mailed to the Center for Health Statistics at the Washington State Department of Health.
Who can use this form
- A birth parent named in the record
- The birth parent completes and signs the form under penalty of perjury, using their name as it appears on the original birth certificate
What to send with it
- The completed and signed form, filled out with information from before the adoption
- A copy of your current photo identification (driver's license or state ID card)
- A $15 check or money order payable to Department of Health
Where to send it
- Mail to
- Center for Health Statistics PO Box 9709 Olympia, Washington 98507-9709
- State fee
- $15
- Typical processing
- Two months, per the office's adoption pages
- Form revision
- May 2018
- Source
- Official government page