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Alleged Natural Fathers Consent To Adoption AD 594 - California
| Alleged Natural Fathers Consent To Adoption Form. This is a California form and can be used in Civil Kings Local County . |
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES IN THE SUPERIOR COURT OF THE STATE OF CALIFORNIA IN AND FOR THE COUNTY OF__________________ In the Matter of the Petition of _______________________________________________ PETITIONER(S) } ALLEGED NATURAL FATHER'S CONSENT TO ADOPTION (In or Out of California) I, ________________________________________ , having been alleged to be the father of ________________________ Name Name of Child ____________________________________ (Gender: M F), born to ___________________________________________ Name of Mother on________________________________________ Date of Birth in ___________________________________________________ Place of Birth give my full and free consent to the adoption of said child by __________________________________________________ Name of Petitioner(s) I understand that I may revoke this consent only during the thirty (30) day period beginning on the date I sign this consent and only if I have not waived my right to revoke the consent. I further understand that with the signing of the order of adoption by the court I shall give up all my rights of custody, services, and earnings of said child and I may not reclaim said child. Signed in the presence of: SIGNATURE OF REPRESENTATIVE: CDSS or Delegated County Adoption Agency DATE CDSS DISTRICT OFFICE OR COUNTY OFFICE SIGNATURE OF ALLEGED NATURAL FATHER ADDRESS FULL ADDRESS TELEPHONE NUMBER - - - OR - - State of County of ) ) ) On ____________________________________ before me, ____________________________________ , a Notary Public, personally appeared ____________________________________ proved to me on the basis of satisfactory evidence to be Name of Alleged Natural Father the person whose name is subscribed to the within instrument and acknowledged to me that he executed the same in his authorized capacity, and that by his signature on the instrument the person, or the entity upon behalf of which the person acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. ________________________________________ (Seal) Signature *(NOTARIZE ONLY WHEN SIGNED OUTSIDE STATE OF CALIFORNIA.) AD 594 (ENG/SP) (3/08) American LegalNet, Inc. www.FormsWorkFlow.com
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