Form Ad 904 PDF Details

Form 904 is an IRS form used to report estate and gift taxes. The form is used to report the decedent's taxable gifts, the value of the gross estate, deductions, and tax on the estate. The form is also used to report any transfers made during the decedent's lifetime that were subject to gift tax. If you have recently inherited property or are responsible for filing a 904 form, it is important to understand how this form works and what information needs to be included. This blog post will provide an overview of Form 904 and explain some of the key components of the form. Stay tuned for future posts that will provide more detail on specific sections of Form 904.

QuestionAnswer
Form NameForm Ad 904
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesad904, california consent form pdf, california ad904, california ad 904 form

Form Preview Example

STATE OF CALIFORNIA – HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES

CONSENT FOR CONTACT

1.Please complete both sides of this form.

2.This form must be witnessed by either a representative of the California Department of Social Services (CDSS) or a California (CA) adoption agency licensed by CDSS, or notarized by a Notary Public.* If the signing of this form is witnessed by a CDSS or adoption agency representative, photo identification of the person signing must be obtained and noted on this form. THIS FORM WILL BE

RETURNED TO YOU IF IT IS NOT WITNESSED OR NOTARIZED

Distribution Instructions:

Original: Agency/Department

Copy: Person Signing

DESIGNATE ONE:

I am the

Birth Parent

Adult Adoptee (age 18 or older)

PART A. To be completed by person signing consent

BIRTH PARENT:

By signing this form, I voluntarily give my consent to the CDSS or licensed adoption agency to disclose my name and address to my adult biological child who was adopted so he/she may contact me.

ADULT ADOPTEE:

By signing this form, I voluntarily give my consent to the CDSS or licensed adoption agency to disclose my name and address to my birth parent(s) so he/she may contact me.

I understand that the CDSS does not provide search services to locate birth parents or adoptees and that these parties must contact CDSS or the licensed adoption agency to request a Consent for Contact (AD 904) form.

I understand that the birth parent(s) and the adoptee must sign a consent before CDSS or the licensed adoption agency may disclose identifying information and that signing this consent does not necessarily ensure that a contact will be made pursuant to Family Code Section 9204. I understand that the law prohibits CDSS or the licensed adoption agency from soliciting, directly or indirectly, the execution of such a consent.

I understand that I should keep the CDSS or the licensed adoption agency informed of my current name and address.

I understand I have the right to rescind this consent at any time by notifying CDSS or the licensed adoption agency in writing.

NAME (PLEASE PRINT)

 

 

OTHER NAME(S) BY WHICH I HAVE BEEN KNOWN

 

 

 

 

 

STREET ADDRESS

CITY

STATE

ZIP CODE

TELEPHONE NUMBER

 

 

 

 

(

)

 

 

 

 

 

 

SIGNATURE

 

 

DATE

 

 

 

 

 

 

 

 

PART B. To be completed by a representative of CDSS or a CA licensed adoption agency. If Part B or C is completed, do not complete Part D.

SIGNATURE OF CDSS /ADOPTION AGENCY REPRESENTATIVE

DATE

TELEPHONE NUMBER

 

 

(

)

 

 

 

AGENCY/DEPARTMENT NAME

ADDRESS

 

 

 

IDENTIFICATION OF BIRTH PARENT/ADULT ADOPTEE (SPECIFY, I.E., DRIVER’S LICENSE, PASSPORT, ETC.)

 

 

 

 

 

PART C.

Check if applicable. Notarized signature has been previously submitted to CDSS or a CA licensed adoption agency.

PART D.

To be completed by a Notary Public ONLY IF Part B or C is not completed.

 

 

 

 

 

 

 

 

 

***COMPLETED BY Notary Public***

The Notary Public must staple the Acknowledgement document to this form and sign and date below.

SIGNATURE OF NOTARY

DATE

*Definition of Notary Public: A Notary Public is a public officer authorized by law to certify documents and to confirm your identity. Notaries may be located at most banks and credit unions or listed in the yellow pages of your local phone directory.

AD 904 (7/11)

SEE REVERSE SIDE

In order to locate the correct adoption file, please assist us by completing the information below. If you do not know this information, please write “unknown”.

______________________________________________________________________________________________

Adoptee’s name, birth date, city and state of birth

______________________________________________________________________________________________

All names used by birth mother at the time of the adoption (include middle and maiden name(s) and name of birth father.)

______________________________________________________________________________________________

Full names of both adoptive parents

Adoptees:

Birth Parents:

Please check the box if you also want to receive nonidentifying background information about

your birth parents.

Please check the box if you also want to receive nonidentifying information about the family that

adopted your child.

Refer to Family Code Sections 8706; 8817 for a full description of nonidentifying information.

What Happens to the Consent

The consent may be sent directly to the adoption agency which handled the adoption, if known, or to the Department’s Central Office: Adoptions Support Unit, Department of Social Services, 744 P Street, M.S. 8-12-31, Sacramento, CA 95814. If the adoption was an independent (private) adoption, the consent will be acknowledged and placed in the adoption file and you will be sent any available information you requested. If the adoption was an agency adoption, the consent will be returned to you with the name and address of the correct agency so you may send it directly to that agency.

AD 904 (7/11)