Pennsylvania > Local County > Chester > Orphans Court > Adoptions
Petition To Confirm Consent To Adoption - Pennsylvania
| Petition To Confirm Consent To Adoption Form. This is a Pennsylvania form and can be used in Adoptions Orphans Court Chester Local County . |
|
||||||
 Get this form for FREE as a print-only pdf |
|||||||
|
[Attorney Caption: name, address, zip code, telephone #, ID #] IN THE COURT OF COMMON PLEAS OF CHESTER COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION IN RE: {use initials only} Case Number: ___________________________ PETITION TO CONFIRM CONSENT TO ADOPTION Petition of ____________________________ under § 2504 of the Adoption Act: 1. [Petitioner's name, address, and relati onship to child. Petitioner must be ediary, Petitioner may be propos ed adoptiv e intermediary or, in the case of no interm parent.] 2. [Child's name, address, age, date and place of birth, racial background, sex, and religious affiliation.] 3. The consent required by § 2711 was exec uted on ___________________. 4. [FOR BIRTH FATHER: A peri od of not less than thirty (30) days has of the child or the execution of Birth Father's consent, elapsed since either the birth whichever occurs later;] [FOR BIRTH MOTHER: A period of not less than thirty (30) days has elapsed since the execution of Birth Mother's consent.] 5. The person who executed the consent has failed to file or proceed with the petition for voluntary relinquishment of parental rights. WHEREFORE, the Petitioner pr ays your Honorable Court to hold a private hearing for the purpose of confirming the intent ion of the parent to relinquish voluntarily his/her parental rights as ev idenced by the consent to the adoption, and further pray fo r American LegalNet, Inc. www.FormsWorkFlow.com a decree terminating the rights of the paren t pursuant to § 2504, awarding custody of the child to [agency] or [indiv idual(s)] and authorizing adoption of the child without further consent or notice to the parent. (Signature) DATE:______________________ (Type Petitioner's Name) American LegalNet, Inc. www.FormsWorkFlow.com VERIFICATION I, ____________________, verify that I am the Petitioner named in the foregoing t forth therein are true and correct, to the best of my Petition and that the facts se knowledge, information and belief. I understand that false statements herein are made subject to the penalties of authorities. 18 Pa. C.S. § 4904 relating to unsworn falsification to (Signature) American LegalNet, Inc. www.FormsWorkFlow.com
|
|||||||
