SOCIAL SERVICES DATA SYSTEMS / CDSS CO. / Adoption / /
Continent
Americas / Africa / /
Country
Cuba / Japan / Guam / Vietnam / Korea / China / Cambodia / Laos / Mexico / Peru / /
Currency
USD / /
Event
Person Travel / /
Facility
clinic Other / / /
IndustryTerm
life support devices / /
Movie
Black and White / /
NaturalFeature
Pacific Islands / Philippine Islands / /
Organization
CDSS Adoption District Office / Public Adoption Agency / Public / UN Court / Social Services Data Systems & Survey Design Bureau / Delegated County Adoption Agency / DEPARTMENT OF SOCIAL SERVICES DATA SYSTEM AND SURVEY DESIGN BUREAU Return / IDENTIFICATION SECTION CALIFORNIA DEPARTMENT OF SOCIAL SERVICES DATA SYSTEMS / Licensed Private California Adoption Agency / Licensed Private Adoption Agency / /
Person
Withdrew / Birth Parent / D. Biological / / /
Position
attorney / social worker / GENERAL INFORMATION An AD 42I / Judicial Officer / Church/minister / Physician /nurse / legal counsel / Judicial Officer of California Court / /
STATE OF CALIFORNIA—HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES DATA SYSTEM AND SURVEY DESIGN BUREAU Return original copy of form to: