093_HB2136eng

 
HB2136 Engrossed                     LRB093 07705 LCB 07893 b

 1        AN ACT concerning adoption.

 2        Be it enacted by the People of  the  State  of  Illinois,
 3    represented in the General Assembly:

 4        Section  5.  The  Adoption  Act  is  amended  by changing
 5    Section 18.2 as follows:

 6        (750 ILCS 50/18.2) (from Ch. 40, par. 1522.2)
 7        Sec. 18.2. Forms.
 8        (a)  The  form   of   the   Birth   Parent   Registration
 9    Identification Form shall be substantially as follows:
10              BIRTH PARENT REGISTRATION IDENTIFICATION
11                   (Insert all known information)
12    I,  .....,  state  that I am the ...... (mother or father) of
13    the following child:
14        Child's original name: ..... (first) ..... (middle) .....
15             (last),  .....  (hour  of  birth),  .....  (date  of
16             birth), ..... (city and state of birth), ..... (name
17             of hospital).
18        Father's full name: ...... (first) ...... (middle)  .....
19             (last), ..... (date of birth), ..... (city and state
20             of birth).
21        Name  of  mother  inserted  on  birth  certificate: .....
22             (first) ..... (middle) ..... (last),  .....  (race),
23             .....  (date  of  birth),  ...... (city and state of
24             birth).
25    That I  surrendered  my  child  to:  .............  (name  of
26        agency),   .....   (city  and  state  of  agency),  .....
27        (approximate date child surrendered).
28    That I placed my child by  private  adoption:  .....  (date),
29        ...... (city and state).
30    Name of adoptive parents, if known: ......
31    Other identifying information: .....
 
HB2136 Engrossed            -2-      LRB093 07705 LCB 07893 b
 1                                         ........................
 2                                            (Signature of parent)
 3    ............                         ........................
 4    (date)                               (printed name of parent)

 5        (b)  The   form   of   the  Adopted  Person  Registration
 6    Identification shall be substantially as follows:
 7                           ADOPTED PERSON
 8                     REGISTRATION IDENTIFICATION
 9                   (Insert all known information)
10    I, ....., state the following:
11        Adopted  Person's  present  name:  .....  (first)   .....
12             (middle) ..... (last).
13        Adopted  Person's name at birth (if known): ..... (first)
14             ..... (middle) .....  (last),  .....  (birth  date),
15             ..... (city and state of birth), ...... (sex), .....
16             (race).
17        Name  of  adoptive  father:  ..... (first) ..... (middle)
18             ..... (last), ..... (race).
19        Maiden name  of  adoptive  mother:  .....  (first)  .....
20             (middle) ..... (last), ..... (race).
21        Name  of  birth  mother  (if  known): ..... (first) .....
22             (middle) ..... (last), ..... (race).
23        Name of birth father  (if  known):  .....  (first)  .....
24             (middle) ..... (last), ..... (race).
25        Name(s)  at  birth  of  sibling(s)  having a common birth
26             parent with adoptee (if known): ..... (first)  .....
27             (middle)  .....  (last),  .....  (race), and name of
28             common birth parent: .....  (first)  .....  (middle)
29             ..... (last), ..... (race).
30    I was adopted through: ..... (name of agency).
31    I was adopted privately: ..... (state "yes" if known).
32    I  was  adopted in ..... (city and state), ..... (approximate
33        date).
34    Other identifying information: .............
 
HB2136 Engrossed            -3-      LRB093 07705 LCB 07893 b
 1                                           ......................
 2                                           (signature of adoptee)
 3    ...........                         .........................
 4    (date)                              (printed name of adoptee)

 5        (c)  The form  of  the  Surrendered  Person  Registration
 6    Identification shall be substantially as follows:
 7                   SURRENDERED PERSON REGISTRATION
 8                           IDENTIFICATION
 9                   (Insert all known information)
10    I, ....., state the following:
11        Surrendered  Person's  present  name: ..... (first) .....
12             (middle) ..... (last).
13        Surrendered Person's name  at  birth  (if  known):  .....
14             (first)  .....  (middle)  .....  (last), .....(birth
15             date), .....  (city  and  state  of  birth),  ......
16             (sex), ..... (race).
17        Name  of  guardian  father:  ..... (first) ..... (middle)
18             ..... (last), ..... (race).
19        Maiden name  of  guardian  mother:  .....  (first)  .....
20             (middle) ..... (last), ..... (race).
21        Name  of  birth  mother  (if  known): ..... (first) .....
22             (middle) ..... (last) ..... (race).
23        Name of birth father  (if  known):  .....  (first)  .....
24             (middle) ..... (last), .....(race).
25        Name(s)  at  birth  of  sibling(s)  having a common birth
26             parent with surrendered  person  (if  known):  .....
27             (first)  .....  (middle) ..... (last), ..... (race),
28             and name of common birth parent: ..... (first) .....
29             (middle) ..... (last), ..... (race).
30    I was surrendered for adoption to: ..... (name of agency).
31    I was surrendered for adoption in  .....  (city  and  state),
32        ..... (approximate date).
33    Other identifying information: ............
34                                 ................................
 
HB2136 Engrossed            -4-      LRB093 07705 LCB 07893 b
 1                                (signature of surrendered person)
 2    ............                           ......................
 3    (date)                                (printed name of person
 4                                        surrendered for adoption)

 5        (d)  The  form  of the Information Exchange Authorization
 6    shall be substantially as follows:
 7                 INFORMATION EXCHANGE AUTHORIZATION
 8        I, ....., state that I am the person  who  completed  the
 9    Registration  Identification;  that  I am of the age of .....
10    years; that I  hereby  authorize  the  Department  of  Public
11    Health   to   give  to  my  (birth  parent)  (birth  sibling)
12    (surrendered  child)  the   following   (please   check   the
13    information authorized for exchange):
14             [  ]  1.  Only my name and last known address.
15             [  ]  2.  A  copy  of  my Illinois Adoption Registry
16        Application.
17             [  ]  3.  A copy of the original certificate of live
18        birth.
19        I am fully aware that I can only  be  supplied  with  any
20    information   about   my   (birth   parent)  (birth  sibling)
21    (surrendered child) if  such  person  has  duly  executed  an
22    Information Exchange Authorization for such information which
23    has  not been revoked; that I can be contacted by writing to:
24    ..... (own name or  name  of  person  to  contact)  (address)
25    (phone number).
26        Dated (insert date).
27    ............                                   ..............
28    (witness)                                         (signature)

29        (e)  The form of the Denial of Information Exchange shall
30    be substantially as follows:
31                   DENIAL OF INFORMATION EXCHANGE
32        I,  .....,  state  that I am the person who completed the
33    Registration Identification; that I am of the  age  of  .....
 
HB2136 Engrossed            -5-      LRB093 07705 LCB 07893 b
 1    years; that I hereby instruct the Department of Public Health
 2    not to give any identifying information about me to my (birth
 3    parent)  (birth  sibling)  (surrendered child); that I do not
 4    wish to be contacted.
 5        Dated (insert date).
 6    .............                                 ...............
 7    (witness)                                         (signature)

 8        (f)  The  Information  Exchange  Authorization  and   the
 9    Denial  of  Information Exchange shall be acknowledged by the
10    birth parent, birth sibling, adopted or  surrendered  person,
11    adoptive parent, or legal guardian before a notary public, in
12    form substantially as follows:
13    State of ..............
14    County of .............
15        I,  a  Notary  Public, in and for the said County, in the
16    State  aforesaid,  do  hereby  certify  that  ...............
17    personally known to me to be the same person  whose  name  is
18    subscribed  to  the foregoing certificate of acknowledgement,
19    appeared before me in person and  acknowledged  that  (he  or
20    she)  signed  such  certificate  as  (his  or  her)  free and
21    voluntary act and that the statements in such certificate are
22    true.
23        Given under my hand and notarial seal on (insert date).
24                                        .........................
25                                                 (signature)

26        (g)  When  the  execution  of  an  Information   Exchange
27    Authorization   or   a  Denial  of  Information  Exchange  is
28    acknowledged before  a  representative  of  an  agency,  such
29    representative  shall  have his signature on said Certificate
30    acknowledged before a notary public, in form substantially as
31    follows:
32    State of..........
33    County of.........
 
HB2136 Engrossed            -6-      LRB093 07705 LCB 07893 b
 1        I, a Notary Public, in and for the said  County,  in  the
 2    State  aforesaid,  do  hereby  certify  that ..... personally
 3    known to me to be the same person whose name is subscribed to
 4    the foregoing certificate of acknowledgement, appeared before
 5    me in person and acknowledged that (he or  she)  signed  such
 6    certificate  as  (his or her) free and voluntary act and that
 7    the statements in such certificate are true.
 8        Given under my hand and notarial seal on (insert date).
 9                                          .......................
10                                                   (signature)

11        (h)  When  an  Illinois  Adoption  Registry  Application,
12    Information Exchange Authorization or a Denial of Information
13    Exchange is executed in a foreign country, the  execution  of
14    such  document  shall  be  acknowledged or affirmed before an
15    officer of the United States consular services.
16        (i)  If  the  person  signing  an  Information   Exchange
17    Authorization  or  a Denial of Information is in the military
18    service of the United States, the execution of such  document
19    may  be  acknowledged  before  a commissioned officer and the
20    signature of  such  officer  on  such  certificate  shall  be
21    verified  or  acknowledged  before a notary public or by such
22    other procedure as is then in effect  for  such  division  or
23    branch of the armed forces.
24        (j)  The Department shall modify these forms as necessary
25    to  implement  the  provisions of this amendatory Act of 1999
26    including  creating  Registration  Identification  Forms  for
27    non-surrendered birth siblings, adoptive  parents  and  legal
28    guardians.
29    (Source: P.A. 91-357, eff. 7-29-99; 91-417, eff. 1-1-00.)

30        Section  99.  Effective date.  This Act takes effect upon
31    becoming law.