Washington Application for Adoption Registration (DOH 422-040)
Official state formAdoptionForm DOH 422-040Free downloadLast verified November 10, 2026
This form registers an adoption with the Center for Health Statistics so a new birth certificate can be created. It covers adoptees born in Washington State and adoptees born outside the United States and adopted in Washington. It is mailed to the Department of Health.
Who can use this form
- The form is completed with the child's original birth information, the name after adoption, the adoptive parents and the attorney and decree details
- A certified copy of the new birth certificate can be requested by the adoptee, the adoptive parents, or the attorney listed on the adoption decree or report of adoption
What to send with it
- The completed Adoption Registration Form, filled out in ink
- A certified copy of the adoption decree from a Washington state court, or the adoption report if the adoption went through another state or U.S. territory court
- The $15 non-refundable adoption registration fee
- Optional: a birth certificate order form, $25 for each certified copy, and a copy of the requestor's identification
- Checks or money orders payable to DOH. All payments sent together can be combined in one
Where to send it
- Mail to
- Attn: Adoptions Center for Health Statistics PO Box 9709 Olympia, WA 98507
- State fee
- $15 adoption registration fee, non-refundable. $25 for each certified copy of the new birth certificate.
- Typical processing
- Two months, per the office's adoption pages
- Form revision
- February 2022
- Source
- Official government page