Statutes: IC 31-19-9-12 and IC 31-19-5
Obtain the form from and return the 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.
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