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Petition For Voluntary Relinquishment Of Parental Rights - Pennsylvania

Petition For Voluntary Relinquishment Of Parental Rights Form. This is a Pennsylvania form and can be used in Orphans Court Westmoreland Local County .
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IN THE ORPHANS' COURT DIVISION OF THE COURT OF COMMON PLEAS OF WESTMORELAND COUNTY, PENNSYLVANIA IN RE: ADOPTION OF (ADOPTEE's name as on birth certificate) : : : : : No: Attorney: OF PETITION FOR VOLUNTARY RELINQUISHMENT OF PARENTAL RIGHTS (23 Pa.C.S.A. §2501 and §2502) RELINQUISHMENT TO: "X" the one that applies. To Agency (23 Pa.C.S.A. § 2501) To Adult(s) intending to adopt (23 Pa.C.S.A. § 2502) RELINQUISHMENT BY: "X" those that apply. BIRTH MOTHER. BIRTH FATHER. PUTATIVE FATHER. TO THE HONORABLE, THE JUDGE OF SAID COURT: The Petition of 1. ADOPTEE: a) b) c) d) e) List name as appears on birth certificate: Age: Date of birth: Birthplace: Sex: Male ( ) Female ( ) . [Names of Relinquishing Parent(s)] American LegalNet, Inc. www.FormsWorkFlow.com f) g) h) i) Present address: Religious affiliation: Racial background: Who has custody of ADOPTEE and since when: 2. BIRTH MOTHER: a) b) c) d) e) f) Name: Maiden name: Age and date of birth: Birthplace: Present address: Present marital status: Married If married, state: (1) (2) (3) g) Date: Place: Name of spouse: Were you married when ADOPTEE was born? [Pennsylvania Supreme Court Orphans' Court Rule No. 15.3(a)] Yes (1) If yes, name of spouse: h) If ADOPTEE was born out of wedlock, do you intend to marry the birth father? [Pennsylvania Supreme Court Orphans' Court Rules 15.2(a)(7) and 15.3(a)] No i) Were you married one year prior to the birth of ADOPTEE? [Pennsylvania Supreme Court Orphans' Court Rule No. 15.3(a)] Yes (1) (2) If yes, name of spouse: If this marriage ended, state how and when: j) The last known address of ADOPTEE's BIRTH FATHER: American LegalNet, Inc. www.FormsWorkFlow.com k) List the names of all other husbands of BIRTH MOTHER: [PA Orphans' Court Rule 15.3(a)] l) What is your employment? m) n) o) Religious affiliation: Racial background: Are you voluntarily relinquishing your parental rights? Yes (1) If yes, state reasons for seeking relinquishment: [Pennsylvania Supreme Court Orphans' Court Rules 15.2(a)(8) and 15.3(a)] (2) (3) Is your consent to the adoption attached? Yes THE PARENT RELINQUISHING PARENTAL RIGHTS MUST PERSONALLY APPEAR IN COURT AT THE VOLUNTARY RELINQUISHMENT HEARING. [23 Pa.C.S.A. § 2503] (4) The BIRTH MOTHER has executed this petition voluntarily to promote what the BIRTH MOTHER believes to be in her best interest and the ADOPTEE's best interest. [Pennsylvania Supreme Court Orphans' Court Rules Nos. 15.2(a)(9) and 15.3(a)] 3. BIRTH FATHER: a) b) c) d) e) Name: Age and date of birth: Birthplace: Present address: Present marital status: Married If married, state: (1) (2) (3) f) Date: Place: Name of spouse: Were you married when ADOPTEE was born? [Pennsylvania Supreme Court Orphans' Court Rule No. 15.3(a)] Yes (1) If yes, name of spouse: American LegalNet, Inc. www.FormsWorkFlow.com g) If ADOPTEE was born out of wedlock, do you intend to marry the birth mother? [Pennsylvania Supreme Court Orphans' Court Rules 15.2(a)(7) and 15.3(a)] No h) Were you married one year prior to the birth of ADOPTEE? [Pennsylvania Supreme Court Orphans' Court Rule No. 15.3(a)] Yes (1) (2) If yes, name of spouse: If this marriage ended, state how and when: i) The last known address of ADOPTEE's BIRTH MOTHER: j) What is your employment? k) l) m) Religious affiliation: Racial background: Are you voluntarily relinquishing your parental rights? Yes (1) If yes, state reasons for seeking relinquishment: [Pennsylvania Supreme Court Orphans' Court Rules 15.2(a)(8) and 15.3(a)] (2) (3) Is your consent to the adoption attached? Yes THE PARENT RELINQUISHING PARENTAL RIGHTS MUST PERSONALLY APPEAR IN COURT AT THE VOLUNTARY RELINQUISHMENT HEARING. [23 Pa.C.S.A. § 2503] (4) The BIRTH FATHER has executed this petition voluntarily to promote what the BIRTH FATHER believes to be in her best interest and the ADOPTEE's best interest. [Pennsylvania Supreme Court Orphans' Court Rules Nos. 15.2(a)(9) and 15.3(a)] 4. PUTATIVE FATHER: a) b) c) d) e) Name: Age and date of birth: Birthplace: Present address: Present marital status: Married American LegalNet, Inc. www.FormsWorkFlow.com If married, state: (1) (2) (3) f) Date: Place: Name of spouse: Were you married when ADOPTEE was born? [Pennsylvania Supreme Court Orphans' Court Rule No. 15.3(a)] Yes (1) If yes, name of spouse: g) If ADOPTEE was born out of wedlock, do you intend to marry the birth mother? [Pennsylvania Supreme Court Orphans' Court Rules 15.2(a)(7) and 15.3(a)] No h) Were you married one year prior to the birth of ADOPTEE? [Pennsylvania Supreme Court Orphans' Court Rule No. 15.3(a)] Yes (1) (2) If yes, name of spouse: If this marriage ended, state how and when: i) Was PUTATIVE FATHER ever married to BIRTH MOTHER? Yes (1) If yes, state when: j) What is your employment? k) l) m) Religious affiliation: Racial background: Are you voluntarily relinquishing your parental rights? Yes (1) If yes, state reasons for seeking relinquishment: [Pennsylvania Supreme Court Orphans' Court Rules 15.2(a)(8) and 15.3(a)] (2) (3) Is your consent to the adoption attached? Yes THE PARENT RELINQUISHING PARENTAL RIGHTS MUST PERSONALLY APPEAR IN COURT AT THE VOLUNTARY RELINQUISHMENT HEARING. [23 Pa.C.S.A. § 2503] American LegalNet, Inc. www.FormsWorkFlow.com (4) The PUTATIVE FATHER has executed this petition voluntarily to promote what the PUTATIVE FATHER believes to be in her best interest and the ADOPTEE's best interest. [Pennsylvania Supreme Court Orphans' Court Rules Nos. 15.2(a)(9) and 15.3(a)] n) Explain the circumstances that created the status of PUTATIVE FATHER: o) A PUTATIVE FATHER'S parental rights may be terminated in these proceedings either by having the PUTATIVE FATHER join in this petition as a petitioner (this will require his testimony at the evidentiary hearing) OR by giving him NOTICE pursuant to 23 Pa.C.S.A. § 2503(d). Is the termination of the parental rights of a PUTATIVE FATHER an objective by either method? Yes p) If this petition does not identify the father of ADOPTEE, attach a certification from the Department of Health as to whether a claim of paternity has been filed pursuant to 23 Pa.C.S.A. § 5103. [23 Pa.C.S.A. § 2503(d)] (1) (2) Has a claim of paternity been filed? Yes 23 Pa.C.S.A. § 2503(b) requires a copy of notice be given to putative father. It further states a putative father shall include one who has filed a claim of paternity as provided in 23 Pa.C.S.A. § 5103 (relating to acknowledgements and claim of paternity) prior to the institution of proceedings. 5. 6. State
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