Certificate Of Relinquishment

CERTIFICATE OF RELINQUISHMENT This certifies that the attached document, executed on (Date) , by (Name) of (Address) , relinquishing custody of the child named (Name), to , an agency authorized to place children for adoption in a suitable home, was executed in accordance with the laws of (State) ; and that the above - name d child was placed for adoption with and ( Names) , of (Address) , who (Has/Have) filed a petition to formally adopt the above - named child in the Court of (Name and Address of Court) . Approval is granted for completion of the above - referenced adoption. In witness whereof, I have signed this instrument in my capacity as the duly authorized r epresentative of (Agency). Signature and Title Date 2001 251 American LegalNet, Inc.