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Form #2103

Rev. 06/2009

Submit to: SECRETARY OF STATE Authentications Unit P O Box 13550 Austin, TX 78711-3550 512-463-5705 Document Fee: $10 (up to $100 per child)

FOR USE IN PROCEEDINGS
RELATING TO THE
ADOPTION OF ONE OR
MORE CHILDREN


REQUEST FOR OFFICIAL
CERTIFICATE OR APOSTILLE--
ADOPTION PROCEEDINGS


Requesting Family
Name: Address:
Street City State Zip

Phone:

Email Address:

Have you made a prior authentication request for use in the same adoption proceedings? Yes No If YES, Customer ID Number: Number of Children Adopting: Name(s): Consulate/Embassy/Country Where Document(s) Will Be Presented:

For Certified Records
Type of Record:

For Notarized Documents
Name of Notary:
Date Commission Expires:
Number of Certificates/Apostilles Requested:

Execution
I certify that the requested authentication(s) is(are) for use in adoption proceedings for one or more children. Date:
Signature of Requestor

Instructions

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· Fee. The fee for an official certificate or apostille for use in a proceeding relating to the adoption of one or more children is $10 per certificate or apostille up to $100 per child. Fees may be paid by personal checks, money orders, LegalEase debit cards or MasterCard, Visa, and Discover credit cards. Checks or money orders must be payable through a U.S. bank or financial institution and made payable to the secretary of state. If paying by credit card, fees are subject to a statutorily authorized convenience fee of 2.7 percent of the total fees, and Form 2101 must also be included. · Multiple Requests. When requesting two or more certificates or apostilles, remit one payment for the total amount. You must complete a separate form for each public official or notary public. · Materials and Return of Documents. The complete, original, certified record or notarized document to be authenticated must be submitted with this form. If the authentication request concerns a translation, the complete document includes both the notarized translation and the document being translated. The document, fees, and form must be submitted with an appropriately sized self-addressed, postage pre-paid envelope for return of documents. · Delivery. Materials may be delivered by mail to P.O. Box 13550, Austin, Texas 78711-3550 or by overnight mail or hand delivery to Room B-05, James Earl Rudder Office Building, 1019 Brazos, Austin, Texas 78701. Hand-delivered documents are accepted weekdays between the hours of 8:00 a.m. and 4:30 p.m.
Form 2103