(a) The full name, permanent address and telephone number of each petitioner;
(b) The current full name, the proposed adoptive name and the date and place of birth of the minor child;
(c) The names, permanent addresses and telephone numbers of any person whose consent to the adoption is required under ORS 109.301 or 109.302;
(d) The name and relationship to the minor child and address of any person or entity for whom the written consent requirement under ORS 109.301 or 109.302 is waived or not required as provided in ORS 109.322, 109.323, 109.324, 109.325, 109.326 and 109.327 or ORS 109.302 or whose written consent may be substituted for the written consent requirement under ORS 109.301 or 109.302 as provided in ORS 109.302 to 109.329;
(e) Whether there is reason to know that the child is an Indian child;
(f) The information required by the Uniform Child Custody Jurisdiction and Enforcement Act under ORS 109.701 to 109.834 except that, when the Department of Human Services or an approved child-caring agency of this or any other state has placed a minor child with a foster parent, the information required under this paragraph regarding the minor child’s address, whereabouts or places the minor child has lived during the past five years, as required under ORS 107.767, is limited to the fact that the minor child was placed with a foster parent and the county and state of the location of the foster care placement, and disclosure of the foster parent’s name and address is specifically exempted from the requirements of this paragraph;
(g) The name, address and telephone number of any adoption agency that will be consenting, or has consented, to the adoption;
(h) The name, bar number and contact information for any attorney representing a petitioner or a person whose consent to the adoption is required under ORS 109.301 or 109.302; and
(i) An indication of the type of adoption proceeding as follows:
(A) Private agency adoption, whether domestic or international;
(B) Nonrelated independent adoption;
(C) Readoption of a minor child adopted in a foreign nation under ORS 109.385;
(D) Relative independent adoption;
(E) Stepparent independent adoption;
(F) An independent adoption involving one petitioner who retains parental rights;
(G) Out-of-state public agency adoption;
(H) An adoption in which the Department of Human Services gives consent under ORS 109.325; or
(I) Any other specified adoption.
(2) An Adoption Summary and Segregated Information Statement must, if applicable, have the following attached as exhibits:
(a) A home study or written evidence that a home study has been approved as required by ORS 109.276, unless waived;
(b) A report of adoption on a form prescribed and furnished by the State Registrar of the Center for Health Statistics as required under ORS 432.223; and
(c) A medical history of the minor child and of the biological parents as required under ORS 109.342.
(3) A waiver of the home study requirement may be substituted for the requirement under subsection (2)(a) of this section.
(4) The petitioner has a continuing duty to inform the court of any change to the information required under this section or when information that was not previously known or ascertainable becomes known or ascertainable.
(5) The Adoption Summary and Segregated Information Statement and the exhibits submitted under subsection (2) of this section are confidential and may not be inspected or copied except as otherwise provided under ORS 109.266 to 109.410 or 109.425 to 109.507. The Adoption Summary and Segregated Information Statement and the exhibits submitted under this section must be segregated in the record of the adoption case from other records, papers and files in the record of the adoption case. [Formerly 109.317]