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Birth Parent Affidavit For Expedited Relinquishment JDF 480 - Colorado
| Birth Parent Affidavit For Expedited Relinquishment Form. This is a Colorado form and can be used in Adoption Statewide . |
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COURT COUNTY . . . . . . . . . . . .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : Index No. District Court Denver Juvenile Court : Calendar No. __________________________________________County, Colorado Court Address: Plaintiff(s) IN THE MATTER OF THE-against- OF: PETITION : : : : JUDICIAL SUBPOENA ______________________________________________________ And _______________________________________________Petitioner(s) FOR THE RELINQUISHMENT OF A CHILD, Defendant(s) ___________________________________________________________ : . . . . . . . . . . . . . . . . . . . . . . . . . . (child's .name). . . . . . . . . . . . . . . . . . . ..... ... Attorney or Party Without Attorney (Name and Address): COURT USE ONLY Case Number: THE PEOPLE OF THE STATE OF NEW YORK Phone Number: TOFAX Number: E-mail: Division Courtroom Atty. Reg. #: BIRTH PARENT AFFIDAVIT FOR EXPEDITED RELINQUISHMENT The Petitioner(s) __________________________________________, being first duly sworn, state the following: GREETINGS: 1. I/we am/are the biological parent(s) of: a child expected to be born on or about__________________________(date). WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable child born on _______________________(date), in ____________________________(city/state) at the Court a whose name is ____________________________________. located at County of in room , on the day of , 20 , at o'clock in the noon, and at any recessed 2. I/we desire to testify and give evidence as a witness in this action on with said child or adjourned date, tovoluntarily relinquish the parent-child legal relationshipthe part of the through an expedited relinquishment process without the necessity of a personal appearance at a court hearing. 3. I/we understand I/we may sign this affidavit before the birth of said child. Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to 4. I/we consent to waive any right to contest a termination of parental rights. the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply. year of age at the time of filing the attached Petition for Relinquishment. 5. Said child will be under one 6. I/we have beenHonorable ______________________________________, a of the Justices placement agency Witness, assisted by , one licensed child of the or county department of social services in the county where I/we reside. Court in County, day of , 20 7. I/we understand the consequences of the relinquishment decision which may include but not be limited to: The irrevocable termination of the right to parent the child. No further parental responsibility for the child. (Attorney must sign above and type name below) The decision is complete and final. Any open adoption agreement that has been entered into with an adoptive family cannot legally be enforced in the State of Colorado. I/we may not inherit from the child, and the child may not inherit from me/us once the adoption is final. Attorney(s) for 8. I/we understand I/we am/are required to obtain relinquishment counseling from a licensed child placement agency or a county department of social services. 9. I/we have completed the required relinquishment counseling, or understand that I/we must complete the Office and P.O. Address required counseling prior to the court entering a Final Order of Relinquishment. Telephone No.: 11. I/we have waived the right to request legal counsel prior toFacsimile No.: signing this Affidavit. E-Mail Address: Mobile JDF 480 7/03 BIRTH PARENT AFFIDAVIT FOR EXPEDITED RELINQUISHMENT Tel. No.: 10. I/we understand I/we have the right to seek additional, independent counseling. Page 1 of 2 American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. 12. I/we understand that I/we may withdraw this Affidavit anytime after signing it, but before the Affidavit and : Calendar No. Petition for Relinquishment are filed with the Court. I/we understand that the Affidavit and Petition for Relinquishment may not be filed with the Court until at least four days after the birth of the child. 13. This relinquishment decision is knowing and voluntary and not the result of any threats, coercion, or undue influence or inducement. -against: 14. I/we believe this relinquishment is in the best interests of the:child. Plaintiff(s) : JUDICIAL SUBPOENA : Defendant(s) : ...................................................... VERIFICATION AND ACKNOWLEDGEMENT THE PEOPLE OF THE STATE I have read the foregoing Birth Parent Affidavit for Expedited Relinquishment and I swear/affirm under oath that OF NEW YORK that the statements set forth therein are true and correct to the best of my knowledge. TO I represent that in signing this Affidavit, I am not under the influence of any drugs or alcohol that would impede my decision-making ability. GREETINGS: ______________________________________ Petitioner Signature Date ___________________________________________ Petitioner Signature Date WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable at the Court located at County of in room , on the day of , 20 , at o'clock in the noon, and at any recessed orSubscribeddate, affirmed, or sworn to before mea witness Subscribed and affirmed, of the adjourned and to testify and give evidence as in this action on the part or sworn to before me in the County of ________________________, State of ____________________, this _______ in the County of _________________________, State of ____________________, this ________ Your failure to comply ____. day of ________________, 20 with this subpoena is punishable ________________, 20 ____. make you liable to day of as a contempt of court and will the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a resultcommission expires: ___________________ of your failure to comply. My My commission expires: ___________________ ______________________________________ Court in County, day of Notary Public/Clerk Witness, Honorable _______________________________________ , 20 Notary Public/Clerk , one of the Justices of the Witness #1: _____________________________ Agency/County Representative Date Witnes
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