Free CCCO 0026 9-20-07.pmd - Illinois

Denial of Paternity with Entry of Appearance and Consent to Adopt IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS COUNTY DEPARTMENT, COUNTY DIVISION IN THE MATTER OF NOTICE TO

(Rev. 9/20/07) CCCO 0026

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PUTATIVE FATHER

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(Street)

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(City) (State) (Zip)

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No. _________________________________

DENIAL OF PATERNITY WITH ENTRY OF APPEARANCE AND CONSENT TO ADOPT (2734)
I, ___________________________________________________________________________________ state: 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 child born on _____________________________, _________, or expected to be born on or about male female

_____________________________, _________ 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.

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Signature

OATH
I have been duly sworn and I say under oath that I have read and understand this Denial of Paternity with Entry of Appearance and Consent to Adoption. The facts it contains are true and correct to the best of my knowledge, and I understand that by signing this document I have not admitted paternity. I have signed this document as my free and voluntary act in order to facilitate the adoption of the child. Date: ___________________________, __________ Signature: ________________________________________

Signed and Sworn before me on this ___________ day of ______________________________________________ Notary Public _________________________________, _________ DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS