4. Attached is a copy of your Affidavit for Child Support, Child Support Order and any other forms required to complete the case. We understand that you are a single parent and your child was born on December 20, 1991, under the birth parent support law. Your child was conceived after the date of the final divorce order which was made in the divorce decree. Attached is a copy of your Adoption Certification, which confirms your child's placement with you on November 16, 1990, under the Adoption Support and Enforcement Act. Your name was entered into the system under this Act, you are a parent of the child, and you are seeking approval to terminate the adoption and adopt him back. Please see the attached document for further information about the adoption law and regulations. The information provided in this document contains most of the information requested for the adoption consideration. This application was prepared on January 23, 1993 by the Department of Social Services for Mr. and Mrs. Michael B. Smith at the Sacramento Office of the Social Services Agency for the purpose of placing Michael as an adoptive child with an adoptive parent. If you have any questions do not hesitate to contact your local SSA Regional Office. Attached please find an appropriate form or letters for you to submit and/or complete. Please check the box to the right and then follow the instructions for the form to complete. The child's name can be entered in the appropriate boxes at the bottom or at the top, whichever you prefer. You should enter his or her date of birth, first name (including his/her maiden name) and last name for identification purposes. If you are submitting the Form I-D, complete all fields except the last four (4) and the Social Security Number field unless you require the Social Security Number. Thank you for your continued interest in this case. Please submit the documents and/or letters listed below and our office will initiate an investigation into this case immediately. PLEASE PROVIDE A COPY OF THIS AND THE FOLLOWING: (1) Affidavit for Child Support, (2) Child Support Order (3) Birth Certificate or other copy of the death certificate of the child. (4) A copy of your Adoption Certification (5) A photograph of the child. (6) A photograph of you (with your full name and date of birth).
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STATE OF CALIFORNIA HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES FEDERAL ELIGIBILITY CERTIFICATION FOR ADOPTION ASSISTANCE PROGRAM Complete one copy and submit it to the
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