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1 | | AN ACT concerning civil law.
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2 | | Be it enacted by the People of the State of Illinois,
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3 | | represented in the General Assembly:
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4 | | Section 5. The Adoption Act is amended by changing Sections |
5 | | 7 and 10 as follows:
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6 | | (750 ILCS 50/7) (from Ch. 40, par. 1509)
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7 | | Sec. 7. Process.
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8 | | A. All persons named in the petition for adoption or |
9 | | standby adoption,
other
than the
petitioners and any party who |
10 | | has previously either denied being a parent
pursuant to Section |
11 | | 12a of this Act or whose rights have been terminated
pursuant |
12 | | to Section 12a of this Act, but including the person sought to |
13 | | be
adopted, shall be made parties defendant by name, and if the |
14 | | name or names
of any such persons are alleged in the petition |
15 | | to be unknown such persons
shall be made parties defendant |
16 | | under the name and style of "All whom it
may concern". In all |
17 | | such actions petitioner or his attorney
shall file, at
the |
18 | | office of the clerk of the court in which the action is |
19 | | pending, an
affidavit showing that the defendant resides or has |
20 | | gone out of this State,
or on due inquiry cannot be found, or |
21 | | is concealed within this State, so
that process cannot be |
22 | | served upon him, and stating the place of residence
of the |
23 | | defendant, if known, or that upon diligent inquiry his place of
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1 | | residence cannot be ascertained, the clerk shall cause |
2 | | publication to be
made in some newspaper published in the |
3 | | county in which the action is
pending. If there is no newspaper |
4 | | published in that county, then the
publication shall be in a |
5 | | newspaper published in an adjoining county in
this State, |
6 | | having a circulation in the county in which such action is
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7 | | pending. In the event there is service on any of the parties by
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8 | | publication, the publication shall contain notice of pendency |
9 | | of the
action, the name of the person to be adopted and the |
10 | | name of the parties to
be served by publication, and the date |
11 | | on or after which default may be
entered against such parties. |
12 | | Neither the name of petitioners nor the name
of any party who |
13 | | has either surrendered said child, has given their consent
to |
14 | | the adoption of the child, or whose parental rights have been |
15 | | terminated
by a court of competent jurisdiction shall be |
16 | | included in the notice of
publication. The Clerk shall also, |
17 | | within ten (10) days of the first
publication of the notice, |
18 | | send a copy thereof by mail, addressed to each
defendant whose |
19 | | place of residence is stated in such affidavit. The
certificate |
20 | | of the Clerk that he sent the copies pursuant to this section
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21 | | is evidence that he has done so. Except as provided in this |
22 | | section
pertaining to service by publication, all parties |
23 | | defendant shall be
notified of the proceedings in the same |
24 | | manner as is now or may hereafter
be required in other civil |
25 | | cases or proceedings , except that service of process need not |
26 | | be directed to a minor defendant under 14 years of age for whom |
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1 | | a guardian ad litem has been or will be appointed pursuant to |
2 | | paragraph (a) of subsection B of Section 13 of this Act . |
3 | | Nothing in the provisions of the preceding sentence stating |
4 | | that service of process need not be directed to a minor |
5 | | defendant under 14 years of age for whom a guardian ad litem |
6 | | has been or will be appointed is intended to override any |
7 | | provision of this Act which relates to information to which an |
8 | | adopted person is entitled under Section 18.1 of this Act. Any |
9 | | party defendant who is
of age of 14 years or upward may waive |
10 | | service of process by entering an
appearance in writing. The |
11 | | form to be used for publication shall be
substantially as |
12 | | follows:
"ADOPTION NOTICE - STATE OF ILLINOIS, County of ...., |
13 | | ss. - Circuit Court
of .... County. In the matter of the |
14 | | Petition for the Adoption of ...., a
..male child. Adoption No. |
15 | | .....
To-- .... (whom it may concern or the named parent)
Take |
16 | | notice that a petition was filed in the Circuit Court of .... |
17 | | County,
Illinois, for the adoption of a child named ..... Now, |
18 | | therefore, unless
you ...., and all whom it may concern, file |
19 | | your answer to the Petition in
the action or otherwise file |
20 | | your appearance therein,
in the said Circuit
Court of ...., |
21 | | County, Room ...., ...., in the City of ...., Illinois, on
or |
22 | | before the .... day of ...., a default may be entered against |
23 | | you at any
time after that day and a judgment entered in |
24 | | accordance with the prayer of
said Petition.
Dated, ...., |
25 | | Illinois, .... ...., Clerk.
(Name and address of attorney for |
26 | | petitioners.)
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1 | | B. A minor defendant who has been served in accordance with |
2 | | this Section
may be defaulted in the same manner as any other |
3 | | defendant.
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4 | | C. Notwithstanding any inconsistent provision of this or |
5 | | any other law,
and in addition to the notice requirements of |
6 | | any law pertaining to persons
other than those specified in |
7 | | this subsection, the persons entitled to notice
that a petition |
8 | | has been filed under Section 5 of this Act shall include:
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9 | | (a) any person adjudicated by a court in this State to |
10 | | be the father of
the child;
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11 | | (b) any person adjudicated by a court of another state |
12 | | or territory of the
United States to be the father of the |
13 | | child, when a certified copy of the court
order has been |
14 | | filed with the Putative Father Registry under Section 12.1 |
15 | | of
this Act;
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16 | | (c) any person who at the time of the filing of the |
17 | | petition is registered
in the Putative Father Registry |
18 | | under Section 12.1 of this Act as the putative
father of |
19 | | the child;
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20 | | (d) any person who is recorded on the child's birth |
21 | | certificate as the
child's father;
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22 | | (e) any person who is openly living with the child or |
23 | | the child's mother
at the time the proceeding is initiated |
24 | | and who is holding himself out to be
the child's father;
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25 | | (f) any person who has been identified as the child's |
26 | | father by the mother
in a written, sworn statement, |
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1 | | including an Affidavit of Identification as
specified |
2 | | under Section 11 of this Act;
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3 | | (g) any person who was married to the child's mother on |
4 | | the date of the
child's birth or within 300 days prior to |
5 | | the child's birth.
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6 | | The sole purpose of notice under this Section shall be to |
7 | | enable the person
receiving notice to appear in the adoption |
8 | | proceedings to present evidence to
the court relevant to |
9 | | whether the consent or surrender of the person to the adoption |
10 | | is required pursuant to Section 8 of this Act. If the court |
11 | | determines that the consent or surrender of the person is not |
12 | | required pursuant to Section 8, then the person shall not be |
13 | | entitled to participate in the proceedings or to any further |
14 | | notice of the proceedings.
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15 | | (Source: P.A. 94-530, eff. 1-1-06.)
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16 | | (750 ILCS 50/10) (from Ch. 40, par. 1512)
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17 | | Sec. 10. Forms of consent and surrender; execution and
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18 | | acknowledgment thereof. |
19 | | A. The form of consent required for the
adoption of a born |
20 | | child shall be substantially as follows:
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21 | | FINAL AND IRREVOCABLE CONSENT TO ADOPTION
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22 | | I, ...., (relationship, e.g., mother, father, relative, |
23 | | guardian)
of ...., a ..male child, state:
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24 | | That such child was born on .... at ....
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25 | | That I reside at ...., County of .... and State of ....
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1 | | That I am of the age of .... years.
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2 | | That I hereby enter my appearance in this proceeding and |
3 | | waive
service of summons on me.
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4 | | That I hereby acknowledge that I have been provided with a |
5 | | copy of the Birth Parent Rights and Responsibilities-Private |
6 | | Form before signing this Consent and that I have had time to |
7 | | read, or have had read to me, this Form. I understand that if I |
8 | | do not receive any of the rights as described in this Form, it |
9 | | shall not constitute a basis to revoke this Final and |
10 | | Irrevocable Consent. |
11 | | That I do hereby consent and agree to the adoption of such |
12 | | child.
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13 | | That I wish to and understand that by signing this consent |
14 | | I do
irrevocably and permanently give up all custody and other |
15 | | parental
rights I have to such child.
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16 | | That I understand such child will be placed for adoption |
17 | | and that I
cannot under any circumstances, after signing this |
18 | | document, change my
mind and revoke or cancel this consent or |
19 | | obtain or recover custody or
any other rights over such child. |
20 | | That I have read and understand the
above and I am signing it |
21 | | as my free and voluntary act.
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22 | | Dated (insert date).
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23 | | .........................
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24 | | If under Section 8 the consent of more than one person is |
25 | | required,
then each such person shall execute a separate |
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1 | | consent.
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2 | | A-1. (1) The form of the Final and Irrevocable Consent to |
3 | | Adoption by a Specified Person or Persons: Non-DCFS Case set |
4 | | forth in this subsection A-1 is to be used by legal parents |
5 | | only. This form is not to be used in cases in which there is a |
6 | | pending petition under Section 2-13 of the Juvenile Court Act |
7 | | of 1987. |
8 | | (2) The form of the Final and Irrevocable Consent to |
9 | | Adoption by a Specified Person or Persons in a non-DCFS case |
10 | | shall have the caption of the proceeding in which it is to be |
11 | | filed and shall be substantially as follows: |
12 | | FINAL AND IRREVOCABLE CONSENT TO ADOPTION BY |
13 | | A SPECIFIED PERSON OR PERSONS; NON-DCFS CASE |
14 | | I, ...., (relationship, e.g., mother, father) of ...., a |
15 | | ..male child, state: |
16 | | 1. That such child was born on ...., at ....., City of ... |
17 | | and State of .... |
18 | | 2. That I reside at ...., County of .... and State of .... |
19 | | 3. That I am of the age of .... years. |
20 | | 4. That I hereby enter my appearance in this proceeding and |
21 | | waive service of summons on me. |
22 | | 5. That I hereby acknowledge that I have been provided a |
23 | | copy of the Birth Parent Rights and Responsibilities-Private |
24 | | Form before signing this Consent and that I have had time to |
25 | | read, or have had read to me, this Form and that I understand |
26 | | the Rights and Responsibilities described in this Form. I |
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1 | | understand that if I do not receive any of my rights as |
2 | | described in said Form, it shall not constitute a basis to |
3 | | revoke this Final and Irrevocable Consent to Adoption by a |
4 | | Specified Person. |
5 | | 6. That I do hereby consent and agree to the adoption of |
6 | | such child by .... (specified persons) only. |
7 | | 7. That I wish to and understand that upon signing this |
8 | | consent I do irrevocably and permanently give up all custody |
9 | | and other parental rights I have to such child if such child is |
10 | | adopted by .... (specified person or persons). I hereby |
11 | | transfer all of my rights to the custody, care and control of |
12 | | such child to ............................. (specified person |
13 | | or persons). |
14 | | 8. That I understand such child will be adopted by |
15 | | ....................... (specified person or persons) and that |
16 | | I cannot under any circumstances, after signing this document, |
17 | | change my mind and revoke or cancel this consent or obtain or |
18 | | recover custody or any other rights over such child if |
19 | | ............................ (specified person or persons) |
20 | | adopt(s) such child; PROVIDED that each specified person has |
21 | | filed or shall file, within 60 days from the date hereof, a |
22 | | petition for the adoption of such child. |
23 | | 9. That if the specified person or persons designated |
24 | | herein do not file a petition for adoption within the |
25 | | time-frame specified above, or, if said petition for adoption |
26 | | is filed within the time-frame specified above but the adoption |
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1 | | petition is dismissed with prejudice or the adoption proceeding |
2 | | is otherwise concluded without an order declaring the child to |
3 | | be the adopted child of the specified person or persons, then I |
4 | | understand that I will receive written notice of such |
5 | | circumstances within 10 business days of their occurrence. I |
6 | | understand that the notice will be directed to me using the |
7 | | contact information I have provided in this consent. I |
8 | | understand that I will have 10 business days from the date that |
9 | | the written notice is sent to me to respond, within which time |
10 | | I may request the Court to declare this consent voidable and |
11 | | return the child to me. I further understand that the Court |
12 | | will make the final decision of whether or not the child will |
13 | | be returned to me. If I do not make such request within 10 |
14 | | business days of the date of the notice, then I expressly waive |
15 | | any other notice or service of process in any legal proceeding |
16 | | for the adoption of the child. |
17 | | 10. That I expressly acknowledge that nothing in this |
18 | | Consent
impairs the validity and absolute finality of this
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19 | | Consent under any circumstance other than those described in
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20 | | paragraph 9 of this Consent. |
21 | | 11. That I understand that I have a remaining duty and
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22 | | obligation to keep .............. (insert name and address of |
23 | | the attorney
for the specified person or persons) informed of |
24 | | my current
address or other preferred contact information until |
25 | | this adoption has been finalized. My failure to
do so may |
26 | | result in the termination of my parental rights and
the child |
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1 | | being placed for adoption in another home. |
2 | | 12. That I do expressly waive any other notice or service |
3 | | of process in any of the legal proceedings for the adoption of |
4 | | the child as long as the adoption proceeding by the specified |
5 | | person or persons is pending. |
6 | | 13. That I have read and understand the above and I am |
7 | | signing it as my free and voluntary act. |
8 | | 14. That I acknowledge that this consent is valid even if |
9 | | the specified person or persons separate or divorce or one of |
10 | | the specified persons dies prior to the entry of the final |
11 | | judgment for adoption. |
12 | | Dated (insert date). |
13 | | ............................................. |
14 | | Signature of parent. |
15 | | ............................................. |
16 | | Address of parent. |
17 | | ............................................. |
18 | | Phone number(s) of parent. |
19 | | ............................................. |
20 | | Personal email(s) of parent. |
21 | | ............................................. |
22 | | (3) The form of the certificate of acknowledgement for a |
23 | | Final and Irrevocable Consent for Adoption by a Specified |
24 | | Person or Persons: Non-DCFS Case shall be substantially as |
25 | | follows: |
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1 | | STATE OF ..............)
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2 | | ) SS.
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3 | | COUNTY OF .............) |
4 | | I, .................... (Name of Judge or other person), |
5 | | ..................... (official title, name, and address), |
6 | | certify that ............., personally known to me to be the |
7 | | same person whose name is subscribed to the foregoing Final and |
8 | | Irrevocable Consent for Adoption by a Specified Person or |
9 | | Persons; non-DCFS case, appeared before me this day in person |
10 | | and acknowledged that (she)(he) signed and delivered the |
11 | | consent as (her)(his) free and voluntary act, for the specified |
12 | | purpose. I am further satisfied that, before signing this |
13 | | Consent, ........ has read, or has had read to him or her, the |
14 | | Birth Parent Rights and Responsibilities-Private Form. |
15 | | A-2. Birth Parent Rights and Responsibilities-Private |
16 | | Form. The Birth Parent Rights and Responsibilities-Private |
17 | | Form must be read by, or have been read to, any person |
18 | | executing a Final and Irrevocable Consent to Adoption under |
19 | | subsection A, a Final and Irrevocable Consent to Adoption by a |
20 | | Specified Person or Persons: Non-DCFS Case under subsection |
21 | | A-1, or a Consent to Adoption of Unborn Child under subsection |
22 | | B prior to the execution of said Consent. The form of the Birth |
23 | | Parent Rights and Responsibilities-Private Form shall be |
24 | | substantially as follows: |
25 | | Birth Parent Rights and Responsibilities-Private Form |
26 | | As a birth parent in the State of Illinois, you have the |
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1 | | right: |
2 | | 1. To have your own attorney represent you. The prospective |
3 | | adoptive parents may agree to pay for the cost of your attorney |
4 | | in a manner consistent with Illinois law, but they are not |
5 | | required to do so. |
6 | | 2. To be treated with dignity and respect at all times and |
7 | | to make decisions free from coercion and pressure. |
8 | | 3. To receive counseling before and after signing a Final |
9 | | and Irrevocable Consent to Adoption ("Consent"), a Final and |
10 | | Irrevocable Consent to Adoption by a Specified Person or |
11 | | Persons: Non-DCFS Case ("Specified Consent"), or a Consent to |
12 | | Adoption of Unborn Child ("Unborn Consent"). The prospective |
13 | | adoptive parents may agree to pay for the cost of counseling in |
14 | | a manner consistent with Illinois law, but they are not |
15 | | required to do so. |
16 | | 4. To ask to be involved in choosing your child's |
17 | | prospective adoptive parents and to ask to meet them. |
18 | | 5. To ask your child's prospective adoptive parents any |
19 | | questions that pertain to your decision to place your child |
20 | | with them. |
21 | | 6. To see your child before signing a Consent or Specified |
22 | | Consent. |
23 | | 7. To request contact with your child and/or the child's |
24 | | prospective adoptive parents, with the understanding that any |
25 | | promises regarding contact with your child or receipt of |
26 | | information about the child after signing a Consent, Specified |
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1 | | Consent, or Unborn Consent cannot be enforced under Illinois |
2 | | law. |
3 | | 8. To receive copies of all documents that you sign and |
4 | | have those documents provided to you in your preferred |
5 | | language. |
6 | | 9. To request that your identifying information remain |
7 | | confidential, unless required otherwise by Illinois law or |
8 | | court order, and to register with the Illinois Adoption |
9 | | Registry and Medical Information Exchange. |
10 | | 10. To work with an adoption agency or attorney of your |
11 | | choice, or change said agency or attorney, provided you |
12 | | promptly inform all of the parties currently involved. |
13 | | 11. To receive, upon request, a written list of any |
14 | | promised support, financial or otherwise, from your attorney or |
15 | | the attorney for your child's prospective adoptive parents. |
16 | | 12. To delay signing a Consent, Specified Consent, or |
17 | | Unborn Consent if you are not ready to do so. |
18 | | 13. To decline to sign a Consent, Specified Consent, or |
19 | | Unborn Consent even if you have received financial support from |
20 | | the prospective adoptive parents. |
21 | | If you do not receive any of the rights described in this |
22 | | Form, it shall not be a basis to revoke a Consent, Specified |
23 | | Consent, or Unborn Consent. |
24 | | As a Birth Parent in the State of Illinois, you have the |
25 | | responsibility: |
26 | | 1. To carefully consider your reasons for choosing |
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1 | | adoption. |
2 | | 2. To voluntarily provide all known medical, background, |
3 | | and family information about yourself and your immediate family |
4 | | to your child's prospective adoptive parents or their attorney. |
5 | | For the health of your child, you are strongly encouraged, but |
6 | | not required, to provide all known medical, background, and |
7 | | family history information about yourself and your family to |
8 | | your child's prospective adoptive parents or their attorney. |
9 | | 3. (Birth mothers only) To accurately complete an Affidavit |
10 | | of Identification, which identifies the father of the child |
11 | | when known, with the understanding that a birth mother has a |
12 | | right to decline to identify the birth father. |
13 | | 4. To not accept financial support or reimbursement of |
14 | | pregnancy related expenses simultaneously from more than one |
15 | | source. |
16 | | B. The form of consent required for the adoption of an |
17 | | unborn child
shall be substantially as follows:
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18 | | CONSENT TO ADOPTION OF UNBORN CHILD
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19 | | I, ...., state:
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20 | | That I am the father of a child expected to be born on or |
21 | | about ....
to .... (name of mother).
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22 | | That I reside at .... County of ...., and State of .....
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23 | | That I am of the age of .... years.
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24 | | That I hereby enter my appearance in such adoption |
25 | | proceeding and
waive service of summons on me.
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26 | | That I hereby acknowledge that I have been provided with a |
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1 | | copy of the Birth Parent Rights and Responsibilities-Private |
2 | | Form before signing this Consent, and that I have had time to |
3 | | read, or have had read to me, this Form. I understand that if I |
4 | | do not receive any of the rights as described in this Form, it |
5 | | shall not constitute a basis to revoke this Consent to Adoption |
6 | | of Unborn Child. |
7 | | That I do hereby consent and agree to the adoption of such |
8 | | child, and
that I have not previously executed a consent or |
9 | | surrender with respect
to such child.
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10 | | That I wish to and do understand that by signing this |
11 | | consent I do
irrevocably and permanently give up all custody |
12 | | and other parental
rights I have to such child, except that I |
13 | | have the right to revoke this
consent by giving written notice |
14 | | of my revocation not later than 72
hours after the birth of the |
15 | | child.
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16 | | That I understand such child will be placed for adoption |
17 | | and that,
except as hereinabove provided, I cannot under any |
18 | | circumstances, after
signing this document, change my mind and |
19 | | revoke or cancel this consent
or obtain or recover custody or |
20 | | any other rights over such child.
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21 | | That I have read and understand the above and I am signing |
22 | | it as my
free and voluntary act.
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23 | | Dated (insert date).
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24 | | ........................
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25 | | B-5. (1) The parent of a child may execute a consent to |
26 | | standby
adoption by a specified person or persons. A consent |
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1 | | under this subsection B-5
shall be acknowledged by a parent |
2 | | pursuant to subsection H and subsection K of
this Section.
The |
3 | | form of consent required for the standby adoption of a born |
4 | | child
effective at a future date when the consenting
parent of |
5 | | the child dies or
requests that a final judgment of adoption be |
6 | | entered shall be substantially as
follows:
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7 | | FINAL AND IRREVOCABLE CONSENT
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8 | | TO STANDBY ADOPTION
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9 | | I, ..., (relationship, e.g. mother or father)
of ...., a |
10 | | ..male child, state:
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11 | | That the child was born on .... at .....
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12 | | That I reside at ...., County of ...., and State of .....
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13 | | That I am of the age of .... years.
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14 | | That I hereby enter my appearance in this proceeding and |
15 | | waive service of
summons on me in this action only.
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16 | | That I do hereby consent and
agree to the standby adoption |
17 | | of the child, and that I have not previously
executed a consent |
18 | | or surrender with respect to the child.
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19 | | That I wish to and understand that by signing this consent |
20 | | I do irrevocably
and permanently give up all custody and other |
21 | | parental rights I have to the
child, effective upon
(my death) |
22 | | (the child's other parent's death) or upon (my) (the other
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23 | | parent's) request for the entry of a final judgment for |
24 | | adoption if .....
(specified person or persons) adopt my child.
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25 | | That I understand that until (I die) (the child's other |
26 | | parent dies), I
retain all legal rights and obligations |
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1 | | concerning the child, but at that time,
I irrevocably give all |
2 | | custody and other parental rights to .... (specified
person or |
3 | | persons).
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4 | | I understand my child will be adopted by ....... (specified |
5 | | person or
persons) only and that I cannot, under any |
6 | | circumstances, after signing this
document, change my mind and |
7 | | revoke or cancel this consent or obtain or recover
custody or |
8 | | any other rights over my child if ..... (specified person or
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9 | | persons) adopt my child.
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10 | | I understand that this consent to standby adoption is valid |
11 | | only if the
petition for standby adoption is filed and that if |
12 | | ....... (specified person or
persons), for any reason, cannot |
13 | | or will not file a petition for standby
adoption or if his, |
14 | | her, or their petition for standby adoption is denied, then
|
15 | | this consent is void. I have the right to notice of any other |
16 | | proceeding that
could affect my parental rights.
|
17 | | That I have read and understand the above and I am signing |
18 | | it as my free and
voluntary act.
|
19 | | Dated (insert date).
|
20 | | ....................
|
21 | | If under Section 8 the consent of more than one person is |
22 | | required, then each
such
person shall execute a separate |
23 | | consent. A separate consent shall be executed
for each
child.
|
24 | | (2) If the parent consents to a standby adoption by 2 |
25 | | specified persons,
then the form shall contain 2 additional |
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1 | | paragraphs in substantially the
following form:
|
2 | | If .... (specified persons) obtain a judgment of
|
3 | | dissolution of
marriage before the judgment for adoption is |
4 | | entered, then .....
(specified person) shall adopt my child. I |
5 | | understand that I cannot change my
mind and revoke this consent |
6 | | or obtain or recover custody of my child if .....
(specified |
7 | | persons) obtain a judgment of dissolution of marriage and .....
|
8 | | (specified person) adopts my child. I understand that I cannot |
9 | | change my
mind and revoke this consent if ...... (specified |
10 | | persons) obtain a
judgment of dissolution of marriage before |
11 | | the adoption is final. I
understand that this consent to |
12 | | adoption has no effect on who will get custody
of my child if |
13 | | ..... (specified persons) obtain a judgment of dissolution
of |
14 | | marriage after the adoption is final. I understand that if |
15 | | either .....
(specified persons) dies before the petition to |
16 | | adopt my child is granted, then
the surviving person may adopt |
17 | | my child. I understand that I cannot change my
mind and revoke |
18 | | this consent or obtain or recover custody of my child if the
|
19 | | surviving person adopts my child.
|
20 | | A consent to standby adoption by specified persons on this |
21 | | form shall have no
effect on a court's determination of custody |
22 | | or visitation under the Illinois
Marriage and Dissolution
of |
23 | | Marriage Act if the marriage of the specified persons is |
24 | | dissolved before
the adoption is final.
|
25 | | (3) The form of the certificate of acknowledgement for a |
26 | | Final and
Irrevocable Consent for Standby Adoption shall be |
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1 | | substantially as follows:
|
2 | | STATE OF .....)
|
3 | | ) SS.
|
4 | | COUNTY OF ....)
|
5 | | I, ....... (name of Judge or other person) ..... (official |
6 | | title,
name, and address), certify that ......., personally |
7 | | known to me to be
the same person whose name is subscribed to |
8 | | the foregoing Final and Irrevocable
Consent to Standby |
9 | | Adoption, appeared before me this day in person and
|
10 | | acknowledged that (she) (he) signed and
delivered the consent |
11 | | as (her) (his) free and voluntary act, for the specified
|
12 | | purpose.
|
13 | | I have fully explained that this consent to adoption is |
14 | | valid only if the
petition to adopt is filed, and that if the |
15 | | specified person or persons, for
any reason, cannot or will not |
16 | | adopt the child or if the adoption petition is
denied, then |
17 | | this consent will be void. I have fully explained that if the
|
18 | | specified person or persons adopt the child, by signing this |
19 | | consent (she) (he)
is irrevocably and permanently |
20 | | relinquishing all parental rights to the child,
and (she) (he) |
21 | | has stated that such is (her) (his) intention and desire.
|
22 | | Dated (insert date).
|
23 | | Signature ..............................
|
24 | | (4) If a consent to standby adoption is executed in this |
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1 | | form,
the consent shall be valid only if the specified
person |
2 | | or persons adopt the child. The consent shall be void if:
|
3 | | (a) the specified person or persons do not file a petition |
4 | | for standby
adoption of the child; or
|
5 | | (b) a court denies the standby adoption petition.
|
6 | | The parent shall not need to take further action to revoke |
7 | | the consent if the
standby adoption by the specified person or |
8 | | persons does not occur,
notwithstanding the provisions of |
9 | | Section 11 of this Act.
|
10 | | C. The form of surrender to any agency given by a parent of |
11 | | a born
child who is to be subsequently placed for adoption |
12 | | shall be
substantially as follows and shall contain such other |
13 | | facts and
statements as the particular agency shall require.
|
14 | | FINAL AND IRREVOCABLE SURRENDER
|
15 | | FOR PURPOSES OF ADOPTION
|
16 | | I, .... (relationship, e.g., mother, father, relative, |
17 | | guardian) of
...., a ..male child, state:
|
18 | | That such child was born on ...., at .....
|
19 | | That I reside at ...., County of ...., and State of .....
|
20 | | That I am of the age of .... years.
|
21 | | That I do hereby surrender and entrust the entire custody |
22 | | and control
of such child to the .... (the "Agency"), a |
23 | | (public) (licensed) child
welfare agency with its principal |
24 | | office in the City of ...., County of
.... and State of ...., |
25 | | for the purpose of enabling it to care for and
supervise the |
26 | | care of such child, to place such child for adoption and
to |
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1 | | consent to the legal adoption of such child.
|
2 | | That I hereby grant to the Agency full power and authority |
3 | | to place
such child with any person or persons it may in its |
4 | | sole discretion
select to become the adopting parent or parents |
5 | | and to consent to the
legal adoption of such child by such |
6 | | person or persons; and to take any
and all measures which, in |
7 | | the judgment of the Agency, may be for the
best interests of |
8 | | such child, including authorizing medical, surgical
and dental |
9 | | care and treatment including inoculation and anaesthesia for
|
10 | | such child.
|
11 | | That I wish to and understand that by signing this |
12 | | surrender I do
irrevocably and permanently give up all custody |
13 | | and other parental
rights I have to such child.
|
14 | | That I understand I cannot under any circumstances, after |
15 | | signing
this surrender, change my mind and revoke or cancel |
16 | | this surrender or
obtain or recover custody or any other rights |
17 | | over such child.
|
18 | | That I have read and understand the above and I am signing |
19 | | it as my
free and voluntary act.
|
20 | | Dated (insert date).
|
21 | | ........................
|
22 | | C-5. The form of a Final and Irrevocable Designated |
23 | | Surrender for Purposes of Adoption to any agency given by a |
24 | | parent of a born child who is to be subsequently placed for |
25 | | adoption is to be used by legal parents only. The form shall be |
26 | | substantially as follows and shall contain such other facts and |
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1 | | statements as the particular agency shall require: |
2 | | FINAL AND IRREVOCABLE DESIGNATED SURRENDER |
3 | | FOR PURPOSES OF ADOPTION |
4 | | I, .... (relationship, e.g., mother, father, relative, |
5 | | guardian) of ...., a ..male child, state: |
6 | | 1. That such child was born on ...., at ..... |
7 | | 2. That I reside at ...., County of ...., and State of |
8 | | ..... |
9 | | 3. That I am of the age of .... years. |
10 | | 4. That I do hereby surrender and entrust the entire |
11 | | custody and control of such child to the .... (the "Agency"), a |
12 | | (public) (licensed) child welfare agency with its principal |
13 | | office in the City of ...., County of .... and State of ...., |
14 | | for the purpose of enabling it to care for and supervise the |
15 | | care of such child, to place such child for adoption with |
16 | | ............................. (specified person or persons) |
17 | | and to consent to the legal adoption of such child and to take |
18 | | any and all measures which, in the judgment of the Agency, may |
19 | | be for the best interests of such child, including authorizing |
20 | | medical, surgical and dental care and treatment including |
21 | | inoculation and anesthesia for such child. |
22 | | 5. That I wish to and understand that by signing this |
23 | | surrender I do irrevocably and permanently give up all custody |
24 | | and other parental rights I have to such child. |
25 | | 6. That if the petition for adoption is not filed by the
|
26 | | specified person or persons designated herein or, if the
|
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1 | | petition for adoption is filed but the adoption petition is
|
2 | | dismissed with prejudice or the adoption proceeding is
|
3 | | otherwise concluded without an order declaring the child to be
|
4 | | the adopted child of each specified person, then I understand |
5 | | that the Agency will provide notice to me within 10 business |
6 | | days and that such notice will be directed to me using the |
7 | | contact information I have provided to the Agency. I understand |
8 | | that I will have 10 business days from the date that the Agency |
9 | | sends me its notice to respond, within which time I may choose |
10 | | to designate other adoptive parent(s). However, I acknowledge |
11 | | that
the Agency has full power and authority to place the child |
12 | | for adoption with
any person or persons it may in its sole |
13 | | discretion select to
become the adopting parent or parents and |
14 | | to consent to the
legal adoption of the child by such person or |
15 | | persons. |
16 | | 7. That I acknowledge that this surrender is valid even if |
17 | | the specified persons separate or divorce or one of the |
18 | | specified persons dies prior to the entry of the final judgment |
19 | | for adoption. |
20 | | 8. That I expressly acknowledge that the above paragraphs 6 |
21 | | and 7 do not impair the validity and absolute finality of this |
22 | | surrender under any circumstance. |
23 | | 9. That I understand that I have a remaining obligation to |
24 | | keep the Agency informed of my current contact information |
25 | | until the adoption of the child has been finalized if I wish to |
26 | | be notified in the event the adoption by the specified |
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1 | | person(s) cannot proceed. |
2 | | 10. That I understand I cannot under any circumstances, |
3 | | after signing this surrender, change my mind and revoke or |
4 | | cancel this surrender or obtain or recover custody or any other |
5 | | rights over such child. |
6 | | 11. That I have read and understand the above and I am |
7 | | signing it as my free and voluntary act. |
8 | | Dated (insert date). |
9 | | .............................. |
10 | | D. The form of surrender to an agency given by a parent of |
11 | | an unborn
child who is to be subsequently placed for adoption |
12 | | shall be
substantially as follows and shall contain such other |
13 | | facts and
statements as the particular agency shall require.
|
14 | | SURRENDER OF UNBORN CHILD FOR
|
15 | | PURPOSES OF ADOPTION
|
16 | | I, .... (father), state:
|
17 | | That I am the father of a child expected to be born on or |
18 | | about ....
to .... (name of mother).
|
19 | | That I reside at ...., County of ...., and State of .....
|
20 | | That I am of the age of .... years.
|
21 | | That I do hereby surrender and entrust the entire custody |
22 | | and control
of such child to the .... (the "Agency"), a |
23 | | (public) (licensed) child
welfare agency with its principal |
24 | | office in the City of ...., County of
.... and State of ...., |
25 | | for the purpose of enabling it to care for and
supervise the |
26 | | care of such child, to place such child for adoption and
to |
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1 | | consent to the legal adoption of such child, and that I have |
2 | | not
previously executed a consent or surrender with respect to |
3 | | such child.
|
4 | | That I hereby grant to the Agency full power and authority |
5 | | to place
such child with any person or persons it may in its |
6 | | sole discretion
select to become the adopting parent or parents |
7 | | and to consent to the
legal adoption of such child by such |
8 | | person or persons; and to take any
and all measures which, in |
9 | | the judgment of the Agency, may be for the
best interests of |
10 | | such child, including authorizing medical, surgical
and dental |
11 | | care and treatment, including inoculation and anaesthesia for
|
12 | | such child.
|
13 | | That I wish to and understand that by signing this |
14 | | surrender I do
irrevocably and permanently give up all custody |
15 | | and other parental
rights I have to such child.
|
16 | | That I understand I cannot under any circumstances, after |
17 | | signing
this surrender, change my mind and revoke or cancel |
18 | | this surrender or
obtain or recover custody or any other rights |
19 | | over such child, except
that I have the right to revoke this |
20 | | surrender by giving written notice
of my revocation not later |
21 | | than 72 hours after the birth of such child.
|
22 | | That I have read and understand the above and I am signing |
23 | | it as my
free and voluntary act.
|
24 | | Dated (insert date).
|
25 | | ........................
|
26 | | E. The form of consent required from the parents for the |
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1 | | adoption of
an adult, when such adult elects to obtain such |
2 | | consent, shall be
substantially as follows:
|
3 | | CONSENT
|
4 | | I, ...., (father) (mother) of ...., an adult, state:
|
5 | | That I reside at ...., County of .... and State of .....
|
6 | | That I do hereby consent and agree to the adoption of such |
7 | | adult by
.... and .....
|
8 | | Dated (insert date).
|
9 | | .........................
|
10 | | F. The form of consent required for the adoption of a child |
11 | | of the
age of 14 years or over upwards , or of an adult, to be |
12 | | given by such person,
shall be substantially as follows:
|
13 | | CONSENT
|
14 | | I, ...., state:
|
15 | | That I reside at ...., County of .... and State of ..... |
16 | | That I am
of the age of .... years. That I hereby enter my |
17 | | appearance in this proceeding and waive service of summons on |
18 | | me. That I consent and agree to my adoption by
.... and .....
|
19 | | Dated (insert date).
|
20 | | ........................
|
21 | | G. The form of consent given by an agency to the adoption |
22 | | by
specified persons of a child previously surrendered to it |
23 | | shall set
forth that the agency has the authority to execute |
24 | | such consent. The
form of consent given by a guardian of the |
25 | | person of a child sought to
be adopted, appointed by a court of |
26 | | competent jurisdiction, shall set
forth the facts of such |
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1 | | appointment and the authority of the guardian to
execute such |
2 | | consent.
|
3 | | H. A consent (other than that given by an agency, or |
4 | | guardian of the
person of the child sought to be adopted who |
5 | | was appointed by a court of
competent jurisdiction) shall be |
6 | | acknowledged by a parent before a judge of a court of competent |
7 | | jurisdiction or, except as otherwise provided in
this Act, |
8 | | before a representative of an agency, or before a person, other |
9 | | than the attorney for the prospective adoptive parent or |
10 | | parents, designated by a court of competent
jurisdiction.
|
11 | | I. A surrender, or any other document equivalent to a |
12 | | surrender, by
which a child is surrendered to an agency shall |
13 | | be acknowledged by the
person signing such surrender, or other |
14 | | document, before a judge of a court of competent jurisdiction, |
15 | | or, except as otherwise provided in this Act, before a |
16 | | representative of an agency, or before a person designated by a |
17 | | court
of competent jurisdiction.
|
18 | | J. The form of the certificate of acknowledgment for a |
19 | | consent, a
surrender, or any other document equivalent to a |
20 | | surrender, shall be
substantially as follows:
|
21 | | STATE OF ....)
|
22 | | ) SS.
|
23 | | COUNTY OF ...)
|
24 | | I, .... (Name of judge or other person), .... (official |
25 | | title, name and
location of court or status or position of |
26 | | other person),
certify that ...., personally known to me to be |
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1 | | the same person whose
name is subscribed to the foregoing |
2 | | (consent) (surrender), appeared
before me this day in person |
3 | | and acknowledged that (she) (he) signed and
delivered such |
4 | | (consent) (surrender) as (her) (his) free and voluntary
act, |
5 | | for the specified purpose.
|
6 | | I have fully explained that by signing such (consent) |
7 | | (surrender)
(she) (he) is irrevocably relinquishing all |
8 | | parental rights to such
child or adult and (she) (he) has |
9 | | stated that such is (her) (his)
intention and desire. (Add if |
10 | | Consent only) I am further satisfied that, before signing this |
11 | | Consent, ........ has read, or has had read to him or her, the |
12 | | Birth Parent Rights and Responsibilities-Private Form.
|
13 | | Dated (insert date).
|
14 | | Signature ...............
|
15 | | K. When the execution of a consent or a surrender is |
16 | | acknowledged
before someone other than a judge,
such other |
17 | | person shall have his or her signature on the certificate
|
18 | | acknowledged before a notary public, in form substantially as |
19 | | follows:
|
20 | | STATE OF ....)
|
21 | | ) SS.
|
22 | | COUNTY OF ...)
|
23 | | I, a Notary Public, in and for the County of ......, in the |
24 | | State of
......, certify that ...., personally known to me to |
25 | | be the
same person whose name is subscribed to the foregoing |
26 | | certificate of
acknowledgment, appeared before me in person and |
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1 | | acknowledged that (she)
(he) signed such certificate as (her) |
2 | | (his) free and voluntary act and
that the statements made in |
3 | | the certificate are true.
|
4 | | Dated (insert date).
|
5 | | Signature ...................... Notary Public
|
6 | | (official seal)
|
7 | | There shall be attached a certificate of magistracy, or |
8 | | other
comparable proof of office of the notary public |
9 | | satisfactory to the
court, to a consent signed and acknowledged |
10 | | in another state.
|
11 | | L. A surrender or consent executed and acknowledged outside |
12 | | of this
State, either in accordance with the law of this State |
13 | | or in accordance
with the law of the place where executed, is |
14 | | valid.
|
15 | | M. Where a consent or a surrender is signed in a foreign |
16 | | country,
the execution of such consent shall be acknowledged or |
17 | | affirmed in a
manner conformable to the law and procedure of |
18 | | such country.
|
19 | | N. If the person signing a consent or surrender is in the |
20 | | military
service of the United States, the execution of such |
21 | | consent or surrender
may be acknowledged before a commissioned |
22 | | officer and the signature of
such officer on such certificate |
23 | | shall be verified or acknowledged
before a notary public or by |
24 | | such other procedure as is then in effect
for such division or |
25 | | branch of the armed forces.
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1 | | O. (1) The parent or parents of a child in whose interests |
2 | | a petition
under Section 2-13 of the Juvenile Court Act of 1987 |
3 | | is pending may, with the
approval of the designated |
4 | | representative of the Department of Children and
Family |
5 | | Services, execute a consent to adoption by a specified person |
6 | | or
persons:
|
7 | | (a) in whose physical custody the child has resided for |
8 | | at least 6
months;
or
|
9 | | (b) in whose physical custody at least one sibling of |
10 | | the child who is the
subject of this consent has resided |
11 | | for at least 6 months, and
the child who is
the subject of |
12 | | this consent is currently residing in this foster home; or
|
13 | | (c) in whose physical custody a child under one year of |
14 | | age has resided
for at least 3 months.
|
15 | | A consent under this subsection O shall be acknowledged by a |
16 | | parent pursuant to
subsection H and subsection K of this |
17 | | Section.
|
18 | | (2) The consent to adoption by a specified person or |
19 | | persons shall have the
caption of the proceeding in which it is |
20 | | to be filed and shall be substantially
as follows:
|
21 | | FINAL AND IRREVOCABLE CONSENT TO ADOPTION BY
|
22 | | A SPECIFIED PERSON OR PERSONS: DCFS CASE
|
23 | | I, ......................................, the |
24 | | .................. (mother or
father) of a ....male child, |
25 | | state:
|
26 | | My child ............................ (name of child) |
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1 | | was born on
(insert date) at .................... Hospital |
2 | | in
................ County, State of ...............
|
3 | | I reside at ......................, County of |
4 | | ............. and
State of ..............
|
5 | | I, ..........................., am .... years old.
|
6 | | I enter my appearance in this action to adopt my child |
7 | | by the
person or persons specified herein by me and waive |
8 | | service of
summons on me in this action only.
|
9 | | I consent to the adoption of my child by
|
10 | | .............................
(specified person or |
11 | | persons) only.
|
12 | | I wish to sign this consent and I understand that by |
13 | | signing this
consent I irrevocably and permanently give up |
14 | | all parental rights I have to my
child if my child is |
15 | | adopted by ............................. (specified person
|
16 | | or persons).
|
17 | | I understand my child will be adopted by |
18 | | .............................
(specified person or |
19 | | persons) only and that I cannot under any circumstances,
|
20 | | after signing this document, change my mind and revoke or |
21 | | cancel this consent
or obtain or recover custody or any |
22 | | other rights over my child if
............................ |
23 | | (specified person or persons) adopt my child.
|
24 | | I understand that this consent to adoption is valid |
25 | | only if the
petition to adopt is filed within one year from |
26 | | the date that I sign it and
that if ....................... |
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1 | | (specified person or persons), for any reason,
cannot or |
2 | | will not file a petition to adopt my child within that one |
3 | | year
period or if their adoption petition is denied, then |
4 | | this consent will be
voidable after one year upon the |
5 | | timely filing of my motion. If I file this
motion before |
6 | | the filing of the petition for adoption, I understand that |
7 | | the
court shall revoke this specific consent.
I have the |
8 | | right to notice of any other proceeding that could affect |
9 | | my
parental rights, except for the proceeding for |
10 | | ............. (specified person
or persons) to adopt my |
11 | | child.
|
12 | | I have read and understand the above and I am signing |
13 | | it as my free
and voluntary act.
|
14 | | Dated (insert date).
|
15 | | .............................................
|
16 | | Signature of parent
|
17 | | (3) If the parent consents to an adoption by 2 specified |
18 | | persons, then the
form shall contain 2 additional paragraphs in |
19 | | substantially the following form:
|
20 | | If ............... (specified persons) get a divorce
|
21 | | before the petition to adopt my child is granted, then |
22 | | ..........
(specified person) shall adopt my child. I |
23 | | understand that I
cannot change my mind and revoke this |
24 | | consent or obtain or
recover custody over my child if |
25 | | ............. (specified persons)
divorce and |
26 | | ............. (specified person) adopts my
child. I |
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1 | | understand that I cannot change my mind and revoke
this |
2 | | consent or obtain or recover custody over my child if
|
3 | | ................. (specified persons) divorce after the
|
4 | | adoption is final. I understand that this consent to |
5 | | adoption
has no effect on who will get custody of my child |
6 | | if they
divorce after the adoption is final.
|
7 | | I understand that if either ...............
|
8 | | (specified persons) dies before the petition to adopt
my |
9 | | child is granted, then the surviving person can adopt my |
10 | | child. I
understand that I cannot change my mind and revoke |
11 | | this consent
or obtain or recover custody over my child if |
12 | | the surviving
person adopts my child.
|
13 | | A consent to adoption by specified persons on this form |
14 | | shall
have no effect on a court's determination of custody or |
15 | | visitation
under the Illinois Marriage and Dissolution of |
16 | | Marriage Act if the
marriage of the
specified persons is |
17 | | dissolved after the adoption is final.
|
18 | | (4) The form of the certificate of acknowledgement for a |
19 | | Final and
Irrevocable Consent for Adoption by a Specified |
20 | | Person or Persons: DCFS Case shall be
substantially as follows:
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21 | | STATE OF ..............)
|
22 | | ) SS.
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23 | | COUNTY OF .............)
|
24 | | I, .................... (Name of Judge or other person),
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1 | | ..................... (official title, name, and address),
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2 | | certify that ............., personally known to me to be the |
3 | | same person whose
name is subscribed to the foregoing Final and |
4 | | Irrevocable Consent for Adoption
by a Specified Person or |
5 | | Persons, appeared before me this day
in person and acknowledged |
6 | | that (she)(he) signed and delivered the consent as
(her)(his) |
7 | | free and voluntary act, for the specified purpose.
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8 | | I have fully explained that this consent to adoption is |
9 | | valid only if the
petition to adopt is filed within one year |
10 | | from the date that it is signed, and
that if the specified |
11 | | person or persons, for any reason, cannot or will not
adopt the |
12 | | child or if the adoption petition is denied, then this consent |
13 | | will
be voidable after one year upon the timely filing of a |
14 | | motion by the parent
to revoke the consent. I explained that if |
15 | | this motion is filed before the
filing of the petition for |
16 | | adoption, the court shall revoke this specific
consent. I have |
17 | | fully explained that if the specified person or
persons adopt
|
18 | | the child, by signing this consent this parent is irrevocably
|
19 | | and permanently
relinquishing all parental rights to the child, |
20 | | and this parent has stated that
such is (her)(his) intention |
21 | | and desire.
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22 | | Dated (insert date).
|
23 | | ...............................
|
24 | | Signature
|
25 | | (5) If a consent to adoption by a specified person or |
26 | | persons is executed in
this form, the following provisions |
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1 | | shall apply. The consent shall be valid
only if that specified |
2 | | person or persons adopt the child. The consent shall be
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3 | | voidable after one year if:
|
4 | | (a) the specified person or persons do not file a |
5 | | petition to adopt the
child within one year after the |
6 | | consent is signed and the parent files a
timely motion to |
7 | | revoke this consent. If this motion is filed before the
|
8 | | filing of the petition for adoption the court shall revoke |
9 | | this consent; or
|
10 | | (b) a court denies the adoption petition; or
|
11 | | (c) the Department of Children and Family Services |
12 | | Guardianship
Administrator determines that the specified |
13 | | person or persons will not or
cannot complete the adoption, |
14 | | or in the best interests of the child should not
adopt the |
15 | | child.
|
16 | | Within 30 days of the consent becoming void, the Department |
17 | | of Children and
Family Services Guardianship Administrator |
18 | | shall make good faith attempts to
notify the parent in writing |
19 | | and shall give written notice to the court and all
additional |
20 | | parties in writing that the adoption has not occurred or will |
21 | | not
occur and that the consent is void. If the adoption by a |
22 | | specified person or
persons does not occur, no proceeding for |
23 | | termination of parental rights shall
be brought unless the |
24 | | biological parent who executed the consent to adoption by
a |
25 | | specified person or persons has been notified of the proceeding |
26 | | pursuant to
Section 7 of this Act or subsection (4) of Section |
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1 | | 2-13 of the Juvenile Court
Act of 1987. The parent shall not |
2 | | need to take further action to revoke the
consent if the |
3 | | specified adoption does not occur, notwithstanding the
|
4 | | provisions of Section 11 of this Act.
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5 | | (6) The Department of Children and Family Services is |
6 | | authorized
to promulgate rules necessary to implement this |
7 | | subsection O.
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8 | | (7) The Department shall collect and maintain data |
9 | | concerning the efficacy
of specific consents. This data shall |
10 | | include the number of specific consents
executed and their |
11 | | outcomes, including but not limited to the number of
children |
12 | | adopted pursuant to the consents, the number of children for |
13 | | whom
adoptions are not completed, and the reason or reasons why |
14 | | the adoptions are
not completed.
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15 | | P. If the person signing a consent is incarcerated or |
16 | | detained in a correctional facility, prison, jail, detention |
17 | | center, or other comparable institution, either in this State |
18 | | or any other jurisdiction, the execution of such consent may be |
19 | | acknowledged before social service personnel of such |
20 | | institution, or before a person designated by a court of |
21 | | competent jurisdiction. |
22 | | Q. A consent may be acknowledged telephonically, via |
23 | | audiovisual connection, or other electronic means, provided |
24 | | that a court of competent jurisdiction has entered an order |
25 | | approving the execution of the consent in such manner and has |
26 | | designated an individual to be physically present with the |
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1 | | parent executing such consent in order to verify the identity |
2 | | of the parent. |
3 | | R. An agency whose representative is acknowledging a |
4 | | consent pursuant to this Section shall be a public child |
5 | | welfare agency, or a child welfare agency, or a child placing |
6 | | agency that is authorized or licensed in the State or |
7 | | jurisdiction in which the consent is signed. |
8 | | S. The form of waiver by a putative or legal father of a |
9 | | born or unborn child shall be substantially as follows: |
10 | | FINAL AND IRREVOCABLE |
11 | | WAIVER OF PARENTAL RIGHTS OF PUTATIVE OR LEGAL FATHER |
12 | | I, .................... , state under oath or affirm as |
13 | | follows: |
14 | | 1. That the biological mother ............... has |
15 | | named me as a possible biological or
legal father of her |
16 | | minor child who was born, or is expected to be born on
|
17 | | ..........., ......, in the City/Town of........., State |
18 | | of ........... |
19 | | 2. That I understand that the biological mother |
20 | | ............. intends to or has placed the child
for |
21 | | adoption. |
22 | | 3. That I reside at ................, in the City/Town |
23 | | of...........,
State of ................ |
24 | | 4. That I am ................ years of age and my date |
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1 | | of birth is ..............., ............. |
2 | | 5. That I (select one): |
3 | | ..... am married to the biological mother. |
4 | | ..... am not married to the biological mother and |
5 | | have not been married to the biological
mother within |
6 | | 300 days before the child's birth or expected date of |
7 | | child's birth. |
8 | | ..... am not currently married to the biological |
9 | | mother, but was married to the biological
mother, |
10 | | within 300 days before the child's birth or expected |
11 | | date of child's birth. |
12 | | 6. That I (select one): |
13 | | ..... neither admit nor deny that I am the |
14 | | biological father of the child. |
15 | | ..... deny that I am the biological father of the |
16 | | child. |
17 | | 7. That I hereby agree to the termination of my |
18 | | parental rights, if any, without further notice to me
of |
19 | | any proceeding for the adoption of the minor child, even if |
20 | | I have taken any action to establish
parental rights or |
21 | | take any such action in the future including registering |
22 | | with any putative father
registry. |
23 | | 8. That I understand that by signing this Waiver I do |
24 | | irrevocably and permanently give up all
custody and other |
25 | | parental rights I may have to such child. |
26 | | 9. That I understand that this Waiver is FINAL AND |
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1 | | IRREVOCABLE and that I am permanently
barred from |
2 | | contesting any proceeding for the adoption of the child |
3 | | after I sign this Waiver. |
4 | | 10. That I waive any further service of summons or |
5 | | other pleadings in any proceeding to terminate
parental |
6 | | rights, if any to this child, or any proceeding for |
7 | | adoption of this child. |
8 | | 11. That I understand that if a final judgment or order |
9 | | of adoption for this child is not entered, then
any |
10 | | parental rights or responsibilities that I may have remain |
11 | | intact. |
12 | | 12. That I have read and understand the above and that |
13 | | I am signing it as my free and voluntary act. |
14 | | Dated: ................... , .............. |
15 | | ........................................... |
16 | | Signature |
17 | | OATH |
18 | | I have been duly sworn and I state under oath that I have read |
19 | | and understood this Final and Irrevocable
Waiver of Parental |
20 | | Rights of Putative or Legal Father. The facts contained in it |
21 | | are true and correct to the
best of my knowledge. I have signed |
22 | | this document as my free and voluntary act in order to |
23 | | facilitate the
adoption of the child. |