Ohio Application for Release of Adopted Name (Biological Parent or Sibling) (HEA 3039)
Official state formAdoptionForm HEA 3039Free downloadLast verified November 10, 2026
Notarized application signed by a biological parent or biological sibling to ask the Ohio Department of Health for an adopted person's adopted name. The name is provided if the Authorization of Release of Adopted Name (HEA 3036) is on file. It is mailed to Special Registration.
Who can use this form
- A biological parent of the adopted person. The parent's name must be on the original birth record.
- A biological sibling of the adopted person. The law quoted on the form refers to a birth sibling age twenty-one or older.
- The biological parent or sibling signs in front of a notary public.
What to send with it
- The completed, notarized application.
- Two forms of identification, such as a driver's license, identification card, marriage application, social security card, military identification card or employee identification card.
- Biological siblings: a photocopy of their own birth record listing one of the same parents shown on the adopted person's original birth record.
- The form warns that other items of identification may be required to verify the relationship to the adopted person.
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