Arkansas Request for an Adopted Person's Original Birth Record (VR-504)
Official state formAdoptionForm VR-504Free downloadLast verified November 10, 2026
Request for the adoption file held by the Arkansas Department of Health. The file has a copy of the original birth certificate from before the adoption, marked not for official use. It is mailed to the State Registrar at the Office of Vital Records in Little Rock.
Who can use this form
- The adopted person, age 21 or older, completes the form.
- The child, surviving spouse, or guardian of the child of a deceased adoptee may also apply. The signer certifies he or she is 21 or older.
- The applicant's signature is notarized.
- A birth parent may have had his or her name redacted from the original birth certificate.
What to send with it
- The completed application with the notarized signature.
- Copies of acceptable forms of ID. The mailing address must match the address on the ID.
- Proof of relationship that links the applicant's name to the adoptee, if the applicant is not the adoptee.
- A $100 check or money order payable to the Arkansas Department of Health. Do not send cash.
Where to send it
- Mail to
- Arkansas Department of Health Office of Vital Records, mail slot 44 State Registrar 4815 West Markham Street Little Rock, AR 72205
- State fee
- $100. The fee is non-refundable.
- Typical processing
- Not provided
- Form revision
- July 2018
- Source
- Official government page