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Presumed Fathers Consent To Adoption (In California) AD 165 - California
| Presumed Fathers Consent To Adoption (In California) 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) } PRESUMED FATHER'S CONSENT TO ADOPTION (In California) I, __________________________________ , being presumed by law to be the father of _______________________ Name Name of Child (Gender: M F ), born to ___________________________________________________ on _____________________ , Name of Mother Place of Birth Date of Birth in ______________________________________________________ declare that I am not the natural father of said child and give my full and free consent to the adoption of said child by _____________________________________________. Name(s) 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. I declare I am not the natural father of said child and am executing this consent to adoption solely for the purpose of promoting the welfare and best interests of said child by facilitating said child's adoption by petitioner(s). Signed in the presence of: SIGNATURE OF REPRESENTATIVE: CDSS or Delegated County Adoption Agency DATE CDSS DISTRICT OFFICE OR COUNTY OFFICE SIGNATURE OF PRESUMED FATHER ADDRESS FULL ADDRESS TELEPHONE NUMBER AD 165 (8/02) (To be used when presumed father denies he is the natural father.) American LegalNet, Inc. www.FormsWorkFlow.com
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