Bill Text: IL HB1699 | 2011-2012 | 97th General Assembly | Introduced
NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Amends the Adoption Act. Provides that one of the statutory forms that is used for purposes of an agency adoption shall only be used by legal parents (instead of unspecified).
Spectrum: Partisan Bill (Democrat 2-0)
Status: (Passed) 2011-08-22 - Public Act . . . . . . . . . 97-0493 [HB1699 Detail]
Download: Illinois-2011-HB1699-Introduced.html
Bill Title: Amends the Adoption Act. Provides that one of the statutory forms that is used for purposes of an agency adoption shall only be used by legal parents (instead of unspecified).
Spectrum: Partisan Bill (Democrat 2-0)
Status: (Passed) 2011-08-22 - Public Act . . . . . . . . . 97-0493 [HB1699 Detail]
Download: Illinois-2011-HB1699-Introduced.html
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1 | AN ACT concerning civil law.
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2 | Be it enacted by the People of the State of Illinois,
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3 | represented in the General Assembly:
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4 | Section 5. The Adoption Act is amended by changing Section | |||||||||||||||||||
5 | 10 as follows:
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6 | (750 ILCS 50/10) (from Ch. 40, par. 1512)
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7 | Sec. 10. Forms of consent and surrender; execution and
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8 | acknowledgment thereof. | |||||||||||||||||||
9 | A. The form of consent required for the
adoption of a born | |||||||||||||||||||
10 | child shall be substantially as follows:
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11 | FINAL AND IRREVOCABLE CONSENT TO ADOPTION
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12 | I, ...., (relationship, e.g., mother, father, relative, | |||||||||||||||||||
13 | guardian)
of ...., a ..male child, state:
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14 | That such child was born on .... at ....
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15 | That I reside at ...., County of .... and State of ....
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16 | That I am of the age of .... years.
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17 | That I hereby enter my appearance in this proceeding and | |||||||||||||||||||
18 | waive
service of summons on me.
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19 | That I hereby acknowledge that I have been provided with a | |||||||||||||||||||
20 | copy of the Birth Parent Rights and Responsibilities-Private | |||||||||||||||||||
21 | Form before signing this Consent and that I have had time to | |||||||||||||||||||
22 | read, or have had read to me, this Form. I understand that if I | |||||||||||||||||||
23 | do not receive any of the rights as described in this Form, it |
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1 | shall not constitute a basis to revoke this Final and | ||||||
2 | Irrevocable Consent. | ||||||
3 | That I do hereby consent and agree to the adoption of such | ||||||
4 | child.
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5 | That I wish to and understand that by signing this consent | ||||||
6 | I do
irrevocably and permanently give up all custody and other | ||||||
7 | parental
rights I have to such child.
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8 | That I understand such child will be placed for adoption | ||||||
9 | and that I
cannot under any circumstances, after signing this | ||||||
10 | document, change my
mind and revoke or cancel this consent or | ||||||
11 | obtain or recover custody or
any other rights over such child. | ||||||
12 | That I have read and understand the
above and I am signing it | ||||||
13 | as my free and voluntary act.
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14 | Dated (insert date).
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15 | .........................
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16 | If under Section 8 the consent of more than one person is | ||||||
17 | required,
then each such person shall execute a separate | ||||||
18 | consent.
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19 | A-1. (1) The form of the Final and Irrevocable Consent to | ||||||
20 | Adoption by a Specified Person or Persons: Non-DCFS Case set | ||||||
21 | forth in this subsection A-1 is to be used by legal parents | ||||||
22 | only. This form is not to be used in cases in which there is a | ||||||
23 | pending petition under Section 2-13 of the Juvenile Court Act | ||||||
24 | of 1987. | ||||||
25 | (2) The form of the Final and Irrevocable Consent to |
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1 | Adoption by a Specified Person or Persons in a non-DCFS case | ||||||
2 | shall have the caption of the proceeding in which it is to be | ||||||
3 | filed and shall be substantially as follows: | ||||||
4 | FINAL AND IRREVOCABLE CONSENT TO ADOPTION BY | ||||||
5 | A SPECIFIED PERSON OR PERSONS; NON-DCFS CASE | ||||||
6 | I, ...., (relationship, e.g., mother, father) of ...., a | ||||||
7 | ..male child, state: | ||||||
8 | 1. That such child was born on ...., at ....., City of ... | ||||||
9 | and State of .... | ||||||
10 | 2. That I reside at ...., County of .... and State of .... | ||||||
11 | 3. That I am of the age of .... years. | ||||||
12 | 4. That I hereby enter my appearance in this proceeding and | ||||||
13 | waive service of summons on me. | ||||||
14 | 5. That I hereby acknowledge that I have been provided a | ||||||
15 | copy of the Birth Parent Rights and Responsibilities-Private | ||||||
16 | Form before signing this Consent and that I have had time to | ||||||
17 | read, or have had read to me, this Form and that I understand | ||||||
18 | the Rights and Responsibilities described in this Form. I | ||||||
19 | understand that if I do not receive any of my rights as | ||||||
20 | described in said Form, it shall not constitute a basis to | ||||||
21 | revoke this Final and Irrevocable Consent to Adoption by a | ||||||
22 | Specified Person. | ||||||
23 | 6. That I do hereby consent and agree to the adoption of | ||||||
24 | such child by .... (specified persons) only. | ||||||
25 | 7. That I wish to and understand that upon signing this | ||||||
26 | consent I do irrevocably and permanently give up all custody |
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1 | and other parental rights I have to such child if such child is | ||||||
2 | adopted by .... (specified person or persons). I hereby | ||||||
3 | transfer all of my rights to the custody, care and control of | ||||||
4 | such child to ............................. (specified person | ||||||
5 | or persons). | ||||||
6 | 8. That I understand such child will be adopted by | ||||||
7 | ....................... (specified person or persons) and that | ||||||
8 | I cannot under any circumstances, after signing this document, | ||||||
9 | change my mind and revoke or cancel this consent or obtain or | ||||||
10 | recover custody or any other rights over such child if | ||||||
11 | ............................ (specified person or persons) | ||||||
12 | adopt(s) such child; PROVIDED that each specified person has | ||||||
13 | filed or shall file, within 60 days from the date hereof, a | ||||||
14 | petition for the adoption of such child. | ||||||
15 | 9. That if the specified person or persons designated | ||||||
16 | herein do not file a petition for adoption within the | ||||||
17 | time-frame specified above, or, if said petition for adoption | ||||||
18 | is filed within the time-frame specified above but the adoption | ||||||
19 | petition is dismissed with prejudice or the adoption proceeding | ||||||
20 | is otherwise concluded without an order declaring the child to | ||||||
21 | be the adopted child of the specified person or persons, then I | ||||||
22 | understand that I will receive written notice of such | ||||||
23 | circumstances within 10 business days of their occurrence. I | ||||||
24 | understand that the notice will be directed to me using the | ||||||
25 | contact information I have provided in this consent. I | ||||||
26 | understand that I will have 10 business days from the date that |
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1 | the written notice is sent to me to respond, within which time | ||||||
2 | I may request the Court to declare this consent voidable and | ||||||
3 | return the child to me. I further understand that the Court | ||||||
4 | will make the final decision of whether or not the child will | ||||||
5 | be returned to me. If I do not make such request within 10 | ||||||
6 | business days of the date of the notice, then I expressly waive | ||||||
7 | any other notice or service of process in any legal proceeding | ||||||
8 | for the adoption of the child. | ||||||
9 | 10. That I expressly acknowledge that nothing in this | ||||||
10 | Consent
impairs the validity and absolute finality of this
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11 | Consent under any circumstance other than those described in
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12 | paragraph 9 of this Consent. | ||||||
13 | 11. That I understand that I have a remaining duty and
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14 | obligation to keep .............. (insert name and address of | ||||||
15 | the attorney
for the specified person or persons) informed of | ||||||
16 | my current
address or other preferred contact information until | ||||||
17 | this adoption has been finalized. My failure to
do so may | ||||||
18 | result in the termination of my parental rights and
the child | ||||||
19 | being placed for adoption in another home. | ||||||
20 | 12. That I do expressly waive any other notice or service | ||||||
21 | of process in any of the legal proceedings for the adoption of | ||||||
22 | the child as long as the adoption proceeding by the specified | ||||||
23 | person or persons is pending. | ||||||
24 | 13. That I have read and understand the above and I am | ||||||
25 | signing it as my free and voluntary act. | ||||||
26 | 14. That I acknowledge that this consent is valid even if |
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1 | the specified person or persons separate or divorce or one of | ||||||
2 | the specified persons dies prior to the entry of the final | ||||||
3 | judgment for adoption. | ||||||
4 | Dated (insert date). | ||||||
5 | ............................................. | ||||||
6 | Signature of parent. | ||||||
7 | ............................................. | ||||||
8 | Address of parent. | ||||||
9 | ............................................. | ||||||
10 | Phone number(s) of parent. | ||||||
11 | ............................................. | ||||||
12 | Personal email(s) of parent. | ||||||
13 | ............................................. | ||||||
14 | (3) The form of the certificate of acknowledgement for a | ||||||
15 | Final and Irrevocable Consent for Adoption by a Specified | ||||||
16 | Person or Persons: Non-DCFS Case shall be substantially as | ||||||
17 | follows:
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18 | STATE OF..............)
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19 | ) SS.
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20 | COUNTY OF.............) | ||||||
21 | I, .................... (Name of Judge or other person), | ||||||
22 | ..................... (official title, name, and address), | ||||||
23 | certify that ............., personally known to me to be the | ||||||
24 | same person whose name is subscribed to the foregoing Final and | ||||||
25 | Irrevocable Consent for Adoption by a Specified Person or |
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1 | Persons; non-DCFS case, appeared before me this day in person | ||||||
2 | and acknowledged that (she)(he) signed and delivered the | ||||||
3 | consent as (her)(his) free and voluntary act, for the specified | ||||||
4 | purpose. I am further satisfied that, before signing this | ||||||
5 | Consent, ........ has read, or has had read to him or her, the | ||||||
6 | Birth Parent Rights and Responsibilities-Private Form. | ||||||
7 | A-2. Birth Parent Rights and Responsibilities-Private | ||||||
8 | Form. The Birth Parent Rights and Responsibilities-Private | ||||||
9 | Form must be read by, or have been read to, any person | ||||||
10 | executing a Final and Irrevocable Consent to Adoption under | ||||||
11 | subsection A, a Final and Irrevocable Consent to Adoption by a | ||||||
12 | Specified Person or Persons: Non-DCFS Case under subsection | ||||||
13 | A-1, or a Consent to Adoption of Unborn Child under subsection | ||||||
14 | B prior to the execution of said Consent. The form of the Birth | ||||||
15 | Parent Rights and Responsibilities-Private Form shall be | ||||||
16 | substantially as follows: | ||||||
17 | Birth Parent Rights and Responsibilities-Private Form | ||||||
18 | As a birth parent in the State of Illinois, you have the | ||||||
19 | right: | ||||||
20 | 1. To have your own attorney represent you. The prospective | ||||||
21 | adoptive parents may agree to pay for the cost of your attorney | ||||||
22 | in a manner consistent with Illinois law, but they are not | ||||||
23 | required to do so. | ||||||
24 | 2. To be treated with dignity and respect at all times and | ||||||
25 | to make decisions free from coercion and pressure. | ||||||
26 | 3. To receive counseling before and after signing a Final |
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1 | and Irrevocable Consent to Adoption ("Consent"), a Final and | ||||||
2 | Irrevocable Consent to Adoption by a Specified Person or | ||||||
3 | Persons: Non-DCFS Case ("Specified Consent"), or a Consent to | ||||||
4 | Adoption of Unborn Child ("Unborn Consent"). The prospective | ||||||
5 | adoptive parents may agree to pay for the cost of counseling in | ||||||
6 | a manner consistent with Illinois law, but they are not | ||||||
7 | required to do so. | ||||||
8 | 4. To ask to be involved in choosing your child's | ||||||
9 | prospective adoptive parents and to ask to meet them. | ||||||
10 | 5. To ask your child's prospective adoptive parents any | ||||||
11 | questions that pertain to your decision to place your child | ||||||
12 | with them. | ||||||
13 | 6. To see your child before signing a Consent or Specified | ||||||
14 | Consent. | ||||||
15 | 7. To request contact with your child and/or the child's | ||||||
16 | prospective adoptive parents, with the understanding that any | ||||||
17 | promises regarding contact with your child or receipt of | ||||||
18 | information about the child after signing a Consent, Specified | ||||||
19 | Consent, or Unborn Consent cannot be enforced under Illinois | ||||||
20 | law. | ||||||
21 | 8. To receive copies of all documents that you sign and | ||||||
22 | have those documents provided to you in your preferred | ||||||
23 | language. | ||||||
24 | 9. To request that your identifying information remain | ||||||
25 | confidential, unless required otherwise by Illinois law or | ||||||
26 | court order, and to register with the Illinois Adoption |
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1 | Registry and Medical Information Exchange. | ||||||
2 | 10. To work with an adoption agency or attorney of your | ||||||
3 | choice, or change said agency or attorney, provided you | ||||||
4 | promptly inform all of the parties currently involved. | ||||||
5 | 11. To receive, upon request, a written list of any | ||||||
6 | promised support, financial or otherwise, from your attorney or | ||||||
7 | the attorney for your child's prospective adoptive parents. | ||||||
8 | 12. To delay signing a Consent, Specified Consent, or | ||||||
9 | Unborn Consent if you are not ready to do so. | ||||||
10 | 13. To decline to sign a Consent, Specified Consent, or | ||||||
11 | Unborn Consent even if you have received financial support from | ||||||
12 | the prospective adoptive parents. | ||||||
13 | If you do not receive any of the rights described in this | ||||||
14 | Form, it shall not be a basis to revoke a Consent, Specified | ||||||
15 | Consent, or Unborn Consent. | ||||||
16 | As a Birth Parent in the State of Illinois, you have the | ||||||
17 | responsibility: | ||||||
18 | 1. To carefully consider your reasons for choosing | ||||||
19 | adoption. | ||||||
20 | 2. To voluntarily provide all known medical, background, | ||||||
21 | and family information about yourself and your immediate family | ||||||
22 | to your child's prospective adoptive parents or their attorney. | ||||||
23 | For the health of your child, you are strongly encouraged, but | ||||||
24 | not required, to provide all known medical, background, and | ||||||
25 | family history information about yourself and your family to | ||||||
26 | your child's prospective adoptive parents or their attorney. |
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1 | 3. (Birth mothers only) To accurately complete an Affidavit | ||||||
2 | of Identification, which identifies the father of the child | ||||||
3 | when known, with the understanding that a birth mother has a | ||||||
4 | right to decline to identify the birth father. | ||||||
5 | 4. To not accept financial support or reimbursement of | ||||||
6 | pregnancy related expenses simultaneously from more than one | ||||||
7 | source. | ||||||
8 | B. The form of consent required for the adoption of an | ||||||
9 | unborn child
shall be substantially as follows:
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10 | CONSENT TO ADOPTION OF UNBORN CHILD
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11 | I, ...., state:
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12 | That I am the father of a child expected to be born on or | ||||||
13 | about ....
to .... (name of mother).
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14 | That I reside at .... County of ...., and State of .....
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15 | That I am of the age of .... years.
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16 | That I hereby enter my appearance in such adoption | ||||||
17 | proceeding and
waive service of summons on me.
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18 | That I hereby acknowledge that I have been provided with a | ||||||
19 | copy of the Birth Parent Rights and Responsibilities-Private | ||||||
20 | Form before signing this Consent, and that I have had time to | ||||||
21 | read, or have had read to me, this Form. I understand that if I | ||||||
22 | do not receive any of the rights as described in this Form, it | ||||||
23 | shall not constitute a basis to revoke this Consent to Adoption | ||||||
24 | of Unborn Child. | ||||||
25 | That I do hereby consent and agree to the adoption of such | ||||||
26 | child, and
that I have not previously executed a consent or |
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1 | surrender with respect
to such child.
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2 | That I wish to and do understand that by signing this | ||||||
3 | consent I do
irrevocably and permanently give up all custody | ||||||
4 | and other parental
rights I have to such child, except that I | ||||||
5 | have the right to revoke this
consent by giving written notice | ||||||
6 | of my revocation not later than 72
hours after the birth of the | ||||||
7 | child.
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8 | That I understand such child will be placed for adoption | ||||||
9 | and that,
except as hereinabove provided, I cannot under any | ||||||
10 | circumstances, after
signing this document, change my mind and | ||||||
11 | revoke or cancel this consent
or obtain or recover custody or | ||||||
12 | any other rights over such child.
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13 | That I have read and understand the above and I am signing | ||||||
14 | it as my
free and voluntary act.
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15 | Dated (insert date).
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16 | ........................
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17 | B-5. (1) The parent of a child may execute a consent to | ||||||
18 | standby
adoption by a specified person or persons. A consent | ||||||
19 | under this subsection B-5
shall be acknowledged by a parent | ||||||
20 | pursuant to subsection H and subsection K of
this Section.
The | ||||||
21 | form of consent required for the standby adoption of a born | ||||||
22 | child
effective at a future date when the consenting
parent of | ||||||
23 | the child dies or
requests that a final judgment of adoption be | ||||||
24 | entered shall be substantially as
follows:
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25 | FINAL AND IRREVOCABLE CONSENT
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26 | TO STANDBY ADOPTION
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1 | I, ..., (relationship, e.g. mother or father)
of ...., a | ||||||
2 | ..male child, state:
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3 | That the child was born on .... at .....
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4 | That I reside at ...., County of ...., and State of .....
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5 | That I am of the age of .... years.
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6 | That I hereby enter my appearance in this proceeding and | ||||||
7 | waive service of
summons on me in this action only.
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8 | That I do hereby consent and
agree to the standby adoption | ||||||
9 | of the child, and that I have not previously
executed a consent | ||||||
10 | or surrender with respect to the child.
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11 | That I wish to and understand that by signing this consent | ||||||
12 | I do irrevocably
and permanently give up all custody and other | ||||||
13 | parental rights I have to the
child, effective upon
(my death) | ||||||
14 | (the child's other parent's death) or upon (my) (the other
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15 | parent's) request for the entry of a final judgment for | ||||||
16 | adoption if .....
(specified person or persons) adopt my child.
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17 | That I understand that until (I die) (the child's other | ||||||
18 | parent dies), I
retain all legal rights and obligations | ||||||
19 | concerning the child, but at that time,
I irrevocably give all | ||||||
20 | custody and other parental rights to .... (specified
person or | ||||||
21 | persons).
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22 | I understand my child will be adopted by ....... (specified | ||||||
23 | person or
persons) only and that I cannot, under any | ||||||
24 | circumstances, after signing this
document, change my mind and | ||||||
25 | revoke or cancel this consent or obtain or recover
custody or | ||||||
26 | any other rights over my child if ..... (specified person or
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1 | persons) adopt my child.
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2 | I understand that this consent to standby adoption is valid | ||||||
3 | only if the
petition for standby adoption is filed and that if | ||||||
4 | ....... (specified person or
persons), for any reason, cannot | ||||||
5 | or will not file a petition for standby
adoption or if his, | ||||||
6 | her, or their petition for standby adoption is denied, then
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7 | this consent is void. I have the right to notice of any other | ||||||
8 | proceeding that
could affect my parental rights.
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9 | That I have read and understand the above and I am signing | ||||||
10 | it as my free and
voluntary act.
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11 | Dated (insert date).
| ||||||
12 | ....................
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13 | If under Section 8 the consent of more than one person is | ||||||
14 | required, then each
such
person shall execute a separate | ||||||
15 | consent. A separate consent shall be executed
for each
child.
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16 | (2) If the parent consents to a standby adoption by 2 | ||||||
17 | specified persons,
then the form shall contain 2 additional | ||||||
18 | paragraphs in substantially the
following form:
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19 | If .... (specified persons) obtain a judgment of
| ||||||
20 | dissolution of
marriage before the judgment for adoption is | ||||||
21 | entered, then .....
(specified person) shall adopt my child. I | ||||||
22 | understand that I cannot change my
mind and revoke this consent | ||||||
23 | or obtain or recover custody of my child if .....
(specified | ||||||
24 | persons) obtain a judgment of dissolution of marriage and .....
| ||||||
25 | (specified person) adopts my child. I understand that I cannot |
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1 | change my
mind and revoke this consent if ...... (specified | ||||||
2 | persons) obtain a
judgment of dissolution of marriage before | ||||||
3 | the adoption is final. I
understand that this consent to | ||||||
4 | adoption has no effect on who will get custody
of my child if | ||||||
5 | ..... (specified persons) obtain a judgment of dissolution
of | ||||||
6 | marriage after the adoption is final. I understand that if | ||||||
7 | either .....
(specified persons) dies before the petition to | ||||||
8 | adopt my child is granted, then
the surviving person may adopt | ||||||
9 | my child. I understand that I cannot change my
mind and revoke | ||||||
10 | this consent or obtain or recover custody of my child if the
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11 | surviving person adopts my child.
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12 | A consent to standby adoption by specified persons on this | ||||||
13 | form shall have no
effect on a court's determination of custody | ||||||
14 | or visitation under the Illinois
Marriage and Dissolution
of | ||||||
15 | Marriage Act if the marriage of the specified persons is | ||||||
16 | dissolved before
the adoption is final.
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17 | (3) The form of the certificate of acknowledgement for a | ||||||
18 | Final and
Irrevocable Consent for Standby Adoption shall be | ||||||
19 | substantially as follows:
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20 | STATE OF .....)
| ||||||
21 | ) SS.
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22 | COUNTY OF ....)
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23 | I, ....... (name of Judge or other person) ..... (official | ||||||
24 | title,
name, and address), certify that ......., personally |
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1 | known to me to be
the same person whose name is subscribed to | ||||||
2 | the foregoing Final and Irrevocable
Consent to Standby | ||||||
3 | Adoption, appeared before me this day in person and
| ||||||
4 | acknowledged that (she) (he) signed and
delivered the consent | ||||||
5 | as (her) (his) free and voluntary act, for the specified
| ||||||
6 | purpose.
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7 | I have fully explained that this consent to adoption is | ||||||
8 | valid only if the
petition to adopt is filed, and that if the | ||||||
9 | specified person or persons, for
any reason, cannot or will not | ||||||
10 | adopt the child or if the adoption petition is
denied, then | ||||||
11 | this consent will be void. I have fully explained that if the
| ||||||
12 | specified person or persons adopt the child, by signing this | ||||||
13 | consent (she) (he)
is irrevocably and permanently | ||||||
14 | relinquishing all parental rights to the child,
and (she) (he) | ||||||
15 | has stated that such is (her) (his) intention and desire.
| ||||||
16 | Dated (insert date).
| ||||||
17 | Signature..............................
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18 | (4) If a consent to standby adoption is executed in this | ||||||
19 | form,
the consent shall be valid only if the specified
person | ||||||
20 | or persons adopt the child. The consent shall be void if:
| ||||||
21 | (a) the specified person or persons do not file a petition | ||||||
22 | for standby
adoption of the child; or
| ||||||
23 | (b) a court denies the standby adoption petition.
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24 | The parent shall not need to take further action to revoke | ||||||
25 | the consent if the
standby adoption by the specified person or | ||||||
26 | persons does not occur,
notwithstanding the provisions of |
| |||||||
| |||||||
1 | Section 11 of this Act.
| ||||||
2 | C. The form of surrender to any agency given by a parent of | ||||||
3 | a born
child who is to be subsequently placed for adoption | ||||||
4 | shall be
substantially as follows and shall contain such other | ||||||
5 | facts and
statements as the particular agency shall require.
| ||||||
6 | FINAL AND IRREVOCABLE SURRENDER
| ||||||
7 | FOR PURPOSES OF ADOPTION
| ||||||
8 | I, .... (relationship, e.g., mother, father, relative, | ||||||
9 | guardian) of
...., a ..male child, state:
| ||||||
10 | That such child was born on ...., at .....
| ||||||
11 | That I reside at ...., County of ...., and State of .....
| ||||||
12 | That I am of the age of .... years.
| ||||||
13 | That I do hereby surrender and entrust the entire custody | ||||||
14 | and control
of such child to the .... (the "Agency"), a | ||||||
15 | (public) (licensed) child
welfare agency with its principal | ||||||
16 | office in the City of ...., County of
.... and State of ...., | ||||||
17 | for the purpose of enabling it to care for and
supervise the | ||||||
18 | care of such child, to place such child for adoption and
to | ||||||
19 | consent to the legal adoption of such child.
| ||||||
20 | That I hereby grant to the Agency full power and authority | ||||||
21 | to place
such child with any person or persons it may in its | ||||||
22 | sole discretion
select to become the adopting parent or parents | ||||||
23 | and to consent to the
legal adoption of such child by such | ||||||
24 | person or persons; and to take any
and all measures which, in | ||||||
25 | the judgment of the Agency, may be for the
best interests of | ||||||
26 | such child, including authorizing medical, surgical
and dental |
| |||||||
| |||||||
1 | care and treatment including inoculation and anaesthesia for
| ||||||
2 | such child.
| ||||||
3 | That I wish to and understand that by signing this | ||||||
4 | surrender I do
irrevocably and permanently give up all custody | ||||||
5 | and other parental
rights I have to such child.
| ||||||
6 | That I understand I cannot under any circumstances, after | ||||||
7 | signing
this surrender, change my mind and revoke or cancel | ||||||
8 | this surrender or
obtain or recover custody or any other rights | ||||||
9 | over such child.
| ||||||
10 | That I have read and understand the above and I am signing | ||||||
11 | it as my
free and voluntary act.
| ||||||
12 | Dated (insert date).
| ||||||
13 | ........................
| ||||||
14 | C-5. The form of a Final and Irrevocable Designated | ||||||
15 | Surrender for Purposes of Adoption to any agency given by a | ||||||
16 | parent of a born child who is to be subsequently placed for | ||||||
17 | adoption is to be used by legal parents only. The form shall be | ||||||
18 | substantially as follows and shall contain such other facts and | ||||||
19 | statements as the particular agency shall require: | ||||||
20 | FINAL AND IRREVOCABLE DESIGNATED SURRENDER | ||||||
21 | FOR PURPOSES OF ADOPTION | ||||||
22 | I, .... (relationship, e.g., mother, father, relative, | ||||||
23 | guardian) of ...., a ..male child, state: | ||||||
24 | 1. That such child was born on ...., at ..... | ||||||
25 | 2. That I reside at ...., County of ...., and State of | ||||||
26 | ..... |
| |||||||
| |||||||
1 | 3. That I am of the age of .... years. | ||||||
2 | 4. That I do hereby surrender and entrust the entire | ||||||
3 | custody and control of such child to the .... (the "Agency"), a | ||||||
4 | (public) (licensed) child welfare agency with its principal | ||||||
5 | office in the City of ...., County of .... and State of ...., | ||||||
6 | for the purpose of enabling it to care for and supervise the | ||||||
7 | care of such child, to place such child for adoption with | ||||||
8 | ............................. (specified person or persons) | ||||||
9 | and to consent to the legal adoption of such child and to take | ||||||
10 | any and all measures which, in the judgment of the Agency, may | ||||||
11 | be for the best interests of such child, including authorizing | ||||||
12 | medical, surgical and dental care and treatment including | ||||||
13 | inoculation and anesthesia for such child. | ||||||
14 | 5. That I wish to and understand that by signing this | ||||||
15 | surrender I do irrevocably and permanently give up all custody | ||||||
16 | and other parental rights I have to such child. | ||||||
17 | 6. That if the petition for adoption is not filed by the
| ||||||
18 | specified person or persons designated herein or, if the
| ||||||
19 | petition for adoption is filed but the adoption petition is
| ||||||
20 | dismissed with prejudice or the adoption proceeding is
| ||||||
21 | otherwise concluded without an order declaring the child to be
| ||||||
22 | the adopted child of each specified person, then I understand | ||||||
23 | that the Agency will provide notice to me within 10 business | ||||||
24 | days and that such notice will be directed to me using the | ||||||
25 | contact information I have provided to the Agency. I understand | ||||||
26 | that I will have 10 business days from the date that the Agency |
| |||||||
| |||||||
1 | sends me its notice to respond, within which time I may choose | ||||||
2 | to designate other adoptive parent(s). However, I acknowledge | ||||||
3 | that
the Agency has full power and authority to place the child | ||||||
4 | for adoption with
any person or persons it may in its sole | ||||||
5 | discretion select to
become the adopting parent or parents and | ||||||
6 | to consent to the
legal adoption of the child by such person or | ||||||
7 | persons. | ||||||
8 | 7. That I acknowledge that this surrender is valid even if | ||||||
9 | the specified persons separate or divorce or one of the | ||||||
10 | specified persons dies prior to the entry of the final judgment | ||||||
11 | for adoption. | ||||||
12 | 8. That I expressly acknowledge that the above paragraphs 6 | ||||||
13 | and 7 do not impair the validity and absolute finality of this | ||||||
14 | surrender under any circumstance. | ||||||
15 | 9. That I understand that I have a remaining obligation to | ||||||
16 | keep the Agency informed of my current contact information | ||||||
17 | until the adoption of the child has been finalized if I wish to | ||||||
18 | be notified in the event the adoption by the specified | ||||||
19 | person(s) cannot proceed. | ||||||
20 | 10. That I understand I cannot under any circumstances, | ||||||
21 | after signing this surrender, change my mind and revoke or | ||||||
22 | cancel this surrender or obtain or recover custody or any other | ||||||
23 | rights over such child. | ||||||
24 | 11. That I have read and understand the above and I am | ||||||
25 | signing it as my free and voluntary act. | ||||||
26 | Dated (insert date). |
| |||||||
| |||||||
1 | .............................. | ||||||
2 | D. The form of surrender to an agency given by a parent of | ||||||
3 | an unborn
child who is to be subsequently placed for adoption | ||||||
4 | shall be
substantially as follows and shall contain such other | ||||||
5 | facts and
statements as the particular agency shall require.
| ||||||
6 | SURRENDER OF UNBORN CHILD FOR
| ||||||
7 | PURPOSES OF ADOPTION
| ||||||
8 | I, .... (father), state:
| ||||||
9 | That I am the father of a child expected to be born on or | ||||||
10 | about ....
to .... (name of mother).
| ||||||
11 | That I reside at ...., County of ...., and State of .....
| ||||||
12 | That I am of the age of .... years.
| ||||||
13 | That I do hereby surrender and entrust the entire custody | ||||||
14 | and control
of such child to the .... (the "Agency"), a | ||||||
15 | (public) (licensed) child
welfare agency with its principal | ||||||
16 | office in the City of ...., County of
.... and State of ...., | ||||||
17 | for the purpose of enabling it to care for and
supervise the | ||||||
18 | care of such child, to place such child for adoption and
to | ||||||
19 | consent to the legal adoption of such child, and that I have | ||||||
20 | not
previously executed a consent or surrender with respect to | ||||||
21 | such child.
| ||||||
22 | That I hereby grant to the Agency full power and authority | ||||||
23 | to place
such child with any person or persons it may in its | ||||||
24 | sole discretion
select to become the adopting parent or parents | ||||||
25 | and to consent to the
legal adoption of such child by such | ||||||
26 | person or persons; and to take any
and all measures which, in |
| |||||||
| |||||||
1 | the judgment of the Agency, may be for the
best interests of | ||||||
2 | such child, including authorizing medical, surgical
and dental | ||||||
3 | care and treatment, including inoculation and anaesthesia for
| ||||||
4 | such child.
| ||||||
5 | That I wish to and understand that by signing this | ||||||
6 | surrender I do
irrevocably and permanently give up all custody | ||||||
7 | and other parental
rights I have to such child.
| ||||||
8 | That I understand I cannot under any circumstances, after | ||||||
9 | signing
this surrender, change my mind and revoke or cancel | ||||||
10 | this surrender or
obtain or recover custody or any other rights | ||||||
11 | over such child, except
that I have the right to revoke this | ||||||
12 | surrender by giving written notice
of my revocation not later | ||||||
13 | than 72 hours after the birth of such child.
| ||||||
14 | That I have read and understand the above and I am signing | ||||||
15 | it as my
free and voluntary act.
| ||||||
16 | Dated (insert date).
| ||||||
17 | ........................
| ||||||
18 | E. The form of consent required from the parents for the | ||||||
19 | adoption of
an adult, when such adult elects to obtain such | ||||||
20 | consent, shall be
substantially as follows:
| ||||||
21 | CONSENT
| ||||||
22 | I, ...., (father) (mother) of ...., an adult, state:
| ||||||
23 | That I reside at ...., County of .... and State of .....
| ||||||
24 | That I do hereby consent and agree to the adoption of such | ||||||
25 | adult by
.... and .....
| ||||||
26 | Dated (insert date).
|
| |||||||
| |||||||
1 | .........................
| ||||||
2 | F. The form of consent required for the adoption of a child | ||||||
3 | of the
age of 14 years or upwards, or of an adult, to be given | ||||||
4 | by such person,
shall be substantially as follows:
| ||||||
5 | CONSENT
| ||||||
6 | I, ...., state:
| ||||||
7 | That I reside at ...., County of .... and State of ..... | ||||||
8 | That I am
of the age of .... years. That I consent and agree to | ||||||
9 | my adoption by
.... and .....
| ||||||
10 | Dated (insert date).
| ||||||
11 | ........................
| ||||||
12 | G. The form of consent given by an agency to the adoption | ||||||
13 | by
specified persons of a child previously surrendered to it | ||||||
14 | shall set
forth that the agency has the authority to execute | ||||||
15 | such consent. The
form of consent given by a guardian of the | ||||||
16 | person of a child sought to
be adopted, appointed by a court of | ||||||
17 | competent jurisdiction, shall set
forth the facts of such | ||||||
18 | appointment and the authority of the guardian to
execute such | ||||||
19 | consent.
| ||||||
20 | H. A consent (other than that given by an agency, or | ||||||
21 | guardian of the
person of the child sought to be adopted who | ||||||
22 | was appointed by a court of
competent jurisdiction) shall be | ||||||
23 | acknowledged by a parent before a judge of a court of competent | ||||||
24 | jurisdiction or, except as otherwise provided in
this Act, | ||||||
25 | before a representative of an agency, or before a person, other | ||||||
26 | than the attorney for the prospective adoptive parent or |
| |||||||
| |||||||
1 | parents, designated by a court of competent
jurisdiction.
| ||||||
2 | I. A surrender, or any other document equivalent to a | ||||||
3 | surrender, by
which a child is surrendered to an agency shall | ||||||
4 | be acknowledged by the
person signing such surrender, or other | ||||||
5 | document, before a judge of a court of competent jurisdiction, | ||||||
6 | or, except as otherwise provided in this Act, before a | ||||||
7 | representative of an agency, or before a person designated by a | ||||||
8 | court
of competent jurisdiction.
| ||||||
9 | J. The form of the certificate of acknowledgment for a | ||||||
10 | consent, a
surrender, or any other document equivalent to a | ||||||
11 | surrender, shall be
substantially as follows:
| ||||||
12 | STATE OF ....)
| ||||||
13 | ) SS.
| ||||||
14 | COUNTY OF ...)
| ||||||
15 | I, .... (Name of judge or other person), .... (official | ||||||
16 | title, name and
location of court or status or position of | ||||||
17 | other person),
certify that ...., personally known to me to be | ||||||
18 | the same person whose
name is subscribed to the foregoing | ||||||
19 | (consent) (surrender), appeared
before me this day in person | ||||||
20 | and acknowledged that (she) (he) signed and
delivered such | ||||||
21 | (consent) (surrender) as (her) (his) free and voluntary
act, | ||||||
22 | for the specified purpose.
| ||||||
23 | I have fully explained that by signing such (consent) | ||||||
24 | (surrender)
(she) (he) is irrevocably relinquishing all | ||||||
25 | parental rights to such
child or adult and (she) (he) has | ||||||
26 | stated that such is (her) (his)
intention and desire. (Add if |
| |||||||
| |||||||
1 | Consent only) I am further satisfied that, before signing this | ||||||
2 | Consent, ........ has read, or has had read to him or her, the | ||||||
3 | Birth Parent Rights and Responsibilities-Private Form.
| ||||||
4 | Dated (insert date).
| ||||||
5 | Signature ...............
| ||||||
6 | K. When the execution of a consent or a surrender is | ||||||
7 | acknowledged
before someone other than a judge,
such other | ||||||
8 | person shall have his or her signature on the certificate
| ||||||
9 | acknowledged before a notary public, in form substantially as | ||||||
10 | follows:
| ||||||
11 | STATE OF ....)
| ||||||
12 | ) SS.
| ||||||
13 | COUNTY OF ...)
| ||||||
14 | I, a Notary Public, in and for the County of ......, in the | ||||||
15 | State of
......, certify that ...., personally known to me to | ||||||
16 | be the
same person whose name is subscribed to the foregoing | ||||||
17 | certificate of
acknowledgment, appeared before me in person and | ||||||
18 | acknowledged that (she)
(he) signed such certificate as (her) | ||||||
19 | (his) free and voluntary act and
that the statements made in | ||||||
20 | the certificate are true.
| ||||||
21 | Dated (insert date).
| ||||||
22 | Signature ...................... Notary Public
| ||||||
23 | (official seal)
| ||||||
24 | There shall be attached a certificate of magistracy, or | ||||||
25 | other
comparable proof of office of the notary public |
| |||||||
| |||||||
1 | satisfactory to the
court, to a consent signed and acknowledged | ||||||
2 | in another state.
| ||||||
3 | L. A surrender or consent executed and acknowledged outside | ||||||
4 | of this
State, either in accordance with the law of this State | ||||||
5 | or in accordance
with the law of the place where executed, is | ||||||
6 | valid.
| ||||||
7 | M. Where a consent or a surrender is signed in a foreign | ||||||
8 | country,
the execution of such consent shall be acknowledged or | ||||||
9 | affirmed in a
manner conformable to the law and procedure of | ||||||
10 | such country.
| ||||||
11 | N. If the person signing a consent or surrender is in the | ||||||
12 | military
service of the United States, the execution of such | ||||||
13 | consent or surrender
may be acknowledged before a commissioned | ||||||
14 | officer and the signature of
such officer on such certificate | ||||||
15 | shall be verified or acknowledged
before a notary public or by | ||||||
16 | such other procedure as is then in effect
for such division or | ||||||
17 | branch of the armed forces.
| ||||||
18 | O. (1) The parent or parents of a child in whose interests | ||||||
19 | a petition
under Section 2-13 of the Juvenile Court Act of 1987 | ||||||
20 | is pending may, with the
approval of the designated | ||||||
21 | representative of the Department of Children and
Family | ||||||
22 | Services, execute a consent to adoption by a specified person | ||||||
23 | or
persons:
| ||||||
24 | (a) in whose physical custody the child has resided for | ||||||
25 | at least 6
months;
or
| ||||||
26 | (b) in whose physical custody at least one sibling of |
| |||||||
| |||||||
1 | the child who is the
subject of this consent has resided | ||||||
2 | for at least 6 months, and
the child who is
the subject of | ||||||
3 | this consent is currently residing in this foster home; or
| ||||||
4 | (c) in whose physical custody a child under one year of | ||||||
5 | age has resided
for at least 3 months.
| ||||||
6 | A consent under this subsection O shall be acknowledged by a | ||||||
7 | parent pursuant to
subsection H and subsection K of this | ||||||
8 | Section.
| ||||||
9 | (2) The consent to adoption by a specified person or | ||||||
10 | persons shall have the
caption of the proceeding in which it is | ||||||
11 | to be filed and shall be substantially
as follows:
| ||||||
12 | FINAL AND IRREVOCABLE CONSENT TO ADOPTION BY
| ||||||
13 | A SPECIFIED PERSON OR PERSONS: DCFS CASE
| ||||||
14 | I, ......................................, the | ||||||
15 | .................. (mother or
father) of a ....male child, | ||||||
16 | state:
| ||||||
17 | My child ............................ (name of child) | ||||||
18 | was born on
(insert date) at .................... Hospital | ||||||
19 | in
................ County, State of ...............
| ||||||
20 | I reside at ......................, County of | ||||||
21 | ............. and
State of ..............
| ||||||
22 | I, ..........................., am .... years old.
| ||||||
23 | I enter my appearance in this action to adopt my child | ||||||
24 | by the
person or persons specified herein by me and waive | ||||||
25 | service of
summons on me in this action only.
| ||||||
26 | I consent to the adoption of my child by
|
| |||||||
| |||||||
1 | .............................
(specified person or | ||||||
2 | persons) only.
| ||||||
3 | I wish to sign this consent and I understand that by | ||||||
4 | signing this
consent I irrevocably and permanently give up | ||||||
5 | all parental rights I have to my
child if my child is | ||||||
6 | adopted by ............................. (specified person
| ||||||
7 | or persons).
| ||||||
8 | I understand my child will be adopted by | ||||||
9 | .............................
(specified person or | ||||||
10 | persons) only and that I cannot under any circumstances,
| ||||||
11 | after signing this document, change my mind and revoke or | ||||||
12 | cancel this consent
or obtain or recover custody or any | ||||||
13 | other rights over my child if
............................ | ||||||
14 | (specified person or persons) adopt my child.
| ||||||
15 | I understand that this consent to adoption is valid | ||||||
16 | only if the
petition to adopt is filed within one year from | ||||||
17 | the date that I sign it and
that if ....................... | ||||||
18 | (specified person or persons), for any reason,
cannot or | ||||||
19 | will not file a petition to adopt my child within that one | ||||||
20 | year
period or if their adoption petition is denied, then | ||||||
21 | this consent will be
voidable after one year upon the | ||||||
22 | timely filing of my motion. If I file this
motion before | ||||||
23 | the filing of the petition for adoption, I understand that | ||||||
24 | the
court shall revoke this specific consent.
I have the | ||||||
25 | right to notice of any other proceeding that could affect | ||||||
26 | my
parental rights, except for the proceeding for |
| |||||||
| |||||||
1 | ............. (specified person
or persons) to adopt my | ||||||
2 | child.
| ||||||
3 | I have read and understand the above and I am signing | ||||||
4 | it as my free
and voluntary act.
| ||||||
5 | Dated (insert date).
| ||||||
6 | .............................................
| ||||||
7 | Signature of parent
| ||||||
8 | (3) If the parent consents to an adoption by 2 specified | ||||||
9 | persons, then the
form shall contain 2 additional paragraphs in | ||||||
10 | substantially the following form:
| ||||||
11 | If ............... (specified persons) get a divorce
| ||||||
12 | before the petition to adopt my child is granted, then | ||||||
13 | ..........
(specified person) shall adopt my child. I | ||||||
14 | understand that I
cannot change my mind and revoke this | ||||||
15 | consent or obtain or
recover custody over my child if | ||||||
16 | ............. (specified persons)
divorce and | ||||||
17 | ............. (specified person) adopts my
child. I | ||||||
18 | understand that I cannot change my mind and revoke
this | ||||||
19 | consent or obtain or recover custody over my child if
| ||||||
20 | ................. (specified persons) divorce after the
| ||||||
21 | adoption is final. I understand that this consent to | ||||||
22 | adoption
has no effect on who will get custody of my child | ||||||
23 | if they
divorce after the adoption is final.
| ||||||
24 | I understand that if either ...............
| ||||||
25 | (specified persons) dies before the petition to adopt
my | ||||||
26 | child is granted, then the surviving person can adopt my |
| |||||||
| |||||||
1 | child. I
understand that I cannot change my mind and revoke | ||||||
2 | this consent
or obtain or recover custody over my child if | ||||||
3 | the surviving
person adopts my child.
| ||||||
4 | A consent to adoption by specified persons on this form | ||||||
5 | shall
have no effect on a court's determination of custody or | ||||||
6 | visitation
under the Illinois Marriage and Dissolution of | ||||||
7 | Marriage Act if the
marriage of the
specified persons is | ||||||
8 | dissolved after the adoption is final.
| ||||||
9 | (4) The form of the certificate of acknowledgement for a | ||||||
10 | Final and
Irrevocable Consent for Adoption by a Specified | ||||||
11 | Person or Persons: DCFS Case shall be
substantially as follows:
| ||||||
12 | STATE OF..............)
| ||||||
13 | ) SS.
| ||||||
14 | COUNTY OF.............)
| ||||||
15 | I, .................... (Name of Judge or other person),
| ||||||
16 | ..................... (official title, name, and address),
| ||||||
17 | certify that ............., personally known to me to be the | ||||||
18 | same person whose
name is subscribed to the foregoing Final and | ||||||
19 | Irrevocable Consent for Adoption
by a Specified Person or | ||||||
20 | Persons, appeared before me this day
in person and acknowledged | ||||||
21 | that (she)(he) signed and delivered the consent as
(her)(his) | ||||||
22 | free and voluntary act, for the specified purpose.
| ||||||
23 | I have fully explained that this consent to adoption is | ||||||
24 | valid only if the
petition to adopt is filed within one year |
| |||||||
| |||||||
1 | from the date that it is signed, and
that if the specified | ||||||
2 | person or persons, for any reason, cannot or will not
adopt the | ||||||
3 | child or if the adoption petition is denied, then this consent | ||||||
4 | will
be voidable after one year upon the timely filing of a | ||||||
5 | motion by the parent
to revoke the consent. I explained that if | ||||||
6 | this motion is filed before the
filing of the petition for | ||||||
7 | adoption, the court shall revoke this specific
consent. I have | ||||||
8 | fully explained that if the specified person or
persons adopt
| ||||||
9 | the child, by signing this consent this parent is irrevocably
| ||||||
10 | and permanently
relinquishing all parental rights to the child, | ||||||
11 | and this parent has stated that
such is (her)(his) intention | ||||||
12 | and desire.
| ||||||
13 | Dated (insert date).
| ||||||
14 | ...............................
| ||||||
15 | Signature
| ||||||
16 | (5) If a consent to adoption by a specified person or | ||||||
17 | persons is executed in
this form, the following provisions | ||||||
18 | shall apply. The consent shall be valid
only if that specified | ||||||
19 | person or persons adopt the child. The consent shall be
| ||||||
20 | voidable after one year if:
| ||||||
21 | (a) the specified person or persons do not file a | ||||||
22 | petition to adopt the
child within one year after the | ||||||
23 | consent is signed and the parent files a
timely motion to | ||||||
24 | revoke this consent. If this motion is filed before the
| ||||||
25 | filing of the petition for adoption the court shall revoke | ||||||
26 | this consent; or
|
| |||||||
| |||||||
1 | (b) a court denies the adoption petition; or
| ||||||
2 | (c) the Department of Children and Family Services | ||||||
3 | Guardianship
Administrator determines that the specified | ||||||
4 | person or persons will not or
cannot complete the adoption, | ||||||
5 | or in the best interests of the child should not
adopt the | ||||||
6 | child.
| ||||||
7 | Within 30 days of the consent becoming void, the Department | ||||||
8 | of Children and
Family Services Guardianship Administrator | ||||||
9 | shall make good faith attempts to
notify the parent in writing | ||||||
10 | and shall give written notice to the court and all
additional | ||||||
11 | parties in writing that the adoption has not occurred or will | ||||||
12 | not
occur and that the consent is void. If the adoption by a | ||||||
13 | specified person or
persons does not occur, no proceeding for | ||||||
14 | termination of parental rights shall
be brought unless the | ||||||
15 | biological parent who executed the consent to adoption by
a | ||||||
16 | specified person or persons has been notified of the proceeding | ||||||
17 | pursuant to
Section 7 of this Act or subsection (4) of Section | ||||||
18 | 2-13 of the Juvenile Court
Act of 1987. The parent shall not | ||||||
19 | need to take further action to revoke the
consent if the | ||||||
20 | specified adoption does not occur, notwithstanding the
| ||||||
21 | provisions of Section 11 of this Act.
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22 | (6) The Department of Children and Family Services is | ||||||
23 | authorized
to promulgate rules necessary to implement this | ||||||
24 | subsection O.
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25 | (7) The Department shall collect and maintain data | ||||||
26 | concerning the efficacy
of specific consents. This data shall |
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| |||||||
1 | include the number of specific consents
executed and their | ||||||
2 | outcomes, including but not limited to the number of
children | ||||||
3 | adopted pursuant to the consents, the number of children for | ||||||
4 | whom
adoptions are not completed, and the reason or reasons why | ||||||
5 | the adoptions are
not completed.
| ||||||
6 | P. If the person signing a consent is incarcerated or | ||||||
7 | detained in a correctional facility, prison, jail, detention | ||||||
8 | center, or other comparable institution, either in this State | ||||||
9 | or any other jurisdiction, the execution of such consent may be | ||||||
10 | acknowledged before social service personnel of such | ||||||
11 | institution, or before a person designated by a court of | ||||||
12 | competent jurisdiction. | ||||||
13 | Q. A consent may be acknowledged telephonically, via | ||||||
14 | audiovisual connection, or other electronic means, provided | ||||||
15 | that a court of competent jurisdiction has entered an order | ||||||
16 | approving the execution of the consent in such manner and has | ||||||
17 | designated an individual to be physically present with the | ||||||
18 | parent executing such consent in order to verify the identity | ||||||
19 | of the parent. | ||||||
20 | R. An agency whose representative is acknowledging a | ||||||
21 | consent pursuant to this Section shall be a public child | ||||||
22 | welfare agency, or a child welfare agency, or a child placing | ||||||
23 | agency that is authorized or licensed in the State or | ||||||
24 | jurisdiction in which the consent is signed. | ||||||
25 | (Source: P.A. 96-601, eff. 8-21-09; 96-1461, eff. 1-1-11.)
|