Indiana

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Statutes: IC 31-19-9-12 and IC 31-19-5

Obtain the form from, and return form to:

Indiana State Department of Health
2 North Meridian Street
Indianapolis, IN 46204
Tel: (317) 233-1325
Fax: (317) 233-1289

Registration forms are available through the State Department of Health or any clerk of a circuit court, branch office of the bureau of motor vehicles, hospital, or local health department.

Submit a registration form by personal delivery, fax, mail, private courier, or express delivery.

Notarization required.

Cost: None indicated.

Researched and Prepared by
Erik L. Smith

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