South Carolina Written Consent to Release Original Birth Certificate (4402-ENG-DPH)
Official state formAdoptionForm 4402-ENG-DPHFree downloadLast verified November 10, 2026
A notarized consent in which the biological parent or parents listed on the original birth certificate allow the adoptee to receive a copy of it and any adoption evidence held with it. The office's website says the adoptee sends it with Form 4019.
Who can use this form
- The biological parent or parents of the adoptee listed on the original birth certificate sign this form
- The birth mother, the father / second parent, or both may sign
- Each signature must be made in the presence of a notary public with an official seal
What to send with it
- The consent, signed and notarized, with no erasures or alterations
- The state file number from the current (post-adoptive) certificate, or the child's birth details exactly as on the original birth certificate
- Per the office's website: the adoptee submits this form with the Form 4019 application
Where to send it
- Mail to
- See the form for where to file it.
- State fee
- No fee or address is printed on this form. The adoptee's application it accompanies (Form 4019) prints a $27 non-refundable fee.
- Typical processing
- Not provided
- Form revision
- 07/2024
- Source
- Official government page