Print Form Clear Form 2734-Denial of Paternity with Entry of Appearance and Consent to Adopt (Rev. 03/21/14) CCCO 0026 IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS COUNTY DEPARTMENT, COUNTY DIVISION IN THE MATTER OF NOTICE TO: __________________________________________________________ Putative Father __________________________________________________________ (Street) No. ________________________________ __________________________________________________________ (City) (State) (Zip Code) DECLARATION OF PATERNITY WITH ENTRY OF APPEARANCE AND CONSENT TO ADOPT (2734) I, ____________________________________________________________________________ state as follows: 1. That I am _____ years of age; that I reside at _________________________________________________________ ________________________________ in the County of _______________________, State of ___________________ 2. That I have been advised that ________________________________________________ is the mother of a male female child born on ___________________________________, __________, or expected to be born on or about ______________________________, _________, and that such mother has stated that I am the father of this child. 3. I DENY that I am the father of this child. 4. I further understand that the mother of this child wishes to consent to the adoption of the child. I hereby consent to the adoption of this child and waive any rights, remedies and defenses that I may now or in the future have as a result of the mother's allegation of paternity of this child. This consent is being given in order to facilitate the adoption of the child and so that the court may terminate what rights I may have to the child as a result of being named the father by the mother. This consent is not in any manner an admission of paternity. 5. I hereby enter my appearance in the above entitled cause and waive service of summons and other pleadings. ________________________________________ Signature OATH Under penalties for perjury provided by Section 1-109 of the Code of Civil procedure I state that I have read and understand this Declaration of Paternity with Entry of Appearance. The facts that it contains are true and correct to the best of my knowledge, and I understand that by signing this document I admit paternity. I have signed this document as my free and voluntary act. Dated: _____________________________,_________ Signature: __________________________________ Printed Name: _____________________________________ Service via email from opposing party/counsel will be accepted at: _______________________________________ by consent pursuant to Ill. Sup. Court Rules 11 and 131. Signed and Sworn before me on this ________ day of ________________________ . ______________________________________________ Notary Public DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS Page 1 of 1
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