Petition To Issue Notice Of Intent To Release Or Consent {PCA 313}

en-USIn the matter of en-USPetitioner þ 1. þ I am pregnant out of wedlock and intend to release the expected child for adoption or to consent to the child222s adoption. 2. þ The approximate date of conception was en-USDateen-US at the following location: þ en-USLocation, including city, county, and state 3. þ The name and address of the putative father of my expected child is * en-USName (type or print) þ en-USAddress City State Zipen-US . 4. þ en-USI requesten-US the court to notify the putative father about his rights to file a notice of intent to claim paternity by issuing and þ serving upon him a notice of intent to release or consent. en-USI declare that this petition has been examined by me and that its contents are true to the best of my information, knowledge, en-USand belief. þ en-USDate en-USAttorney signature þ en-USSignature of petitioner þ en-USAttorney name (type or print) Bar no. þ en-USName (type or print) en-USAddress þ en-USAddress en-USCity, state, zip Telephone no. þ en-USCity, state, zip Telephone no.en-US*The petition may include more than one putative father where circumstances warrant it. American LegalNet, Inc. www.FormsWorkFlow.com