Part 1 particulars to be entered where the record of the birth was created in the adopted children register on or after 1st July 1930 and on or before 30th April 1950

No. of Entry

Date of Entry

Name (not including surname) by which it is intended that the Adopted Child shall be known.

Sex of Adopted Child.

Name and Surname, Address and Occupation of Adopter or Adopters.

Date of Birth of Child, and if Birthplace is not in Northern Ireland, Country of Birth.

Date of Adoption Order and Description of Court by which made.

Signature of Officer deputed by Registrar General to attest the Entry.