Ohio Rescission of Authorization of Release of Adopted Name (HEA 3037)
Official state formAdoptionForm HEA 3037Free downloadLast verified November 10, 2026
Notarized form that cancels an Authorization of Release of Adopted Name previously filed with the Ohio Department of Health. The person who signs it gives their name and address. It is mailed to the department's Special Registration unit.
Who can use this form
- The person who previously filed an Authorization of Release of Adopted Name. The signature line on this form does not name the signer.
- The signer may undo the rescission by filing a new Authorization of Release of Adopted Name, and may do so as often as they wish.
What to send with it
- The completed form with the signer's name, address, signature and date.
- Notarization before the form is sent.
- Two forms of identification, such as a driver's license, identification card, marriage application, social security card, military identification card or employee identification card.
Where to send it
- Mail to
- Ohio Department of Health Attn: Special Registration P.O. Box 15098 Columbus, Ohio 43215
- State fee
- Not provided
- Typical processing
- Not provided
- Form revision
- Rev. 03/2025
- Source
- Official government page