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Alleged Natural Fathers Consent To Adoption Form. This is a California form and can be use in Kings Local County.
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Tags: Alleged Natural Fathers Consent To Adoption, AD 594, California Local County, Kings
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
IN THE SUPERIOR COURT OF THE STATE OF CALIFORNIA
IN AND FOR THE COUNTY OF__________________
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In the Matter of the Petition of
_______________________________________________
PETITIONER(S)
ALLEGED NATURAL FATHER’S
CONSENT TO ADOPTION
(In or Out of California)
I, ________________________________________ , having been alleged to be the father of ________________________
Name
Name of Child
____________________________________ (Gender: M F), born to ___________________________________________
Name of Mother
on________________________________________
in ___________________________________________________
Place of Birth
Date of Birth
give my full and free consent to the adoption of said child by __________________________________________________
Name of Petitioner(s)
I understand that I may revoke this consent only during the thirty (30) day period beginning on the date I sign this consent
and only if I have not waived my right to revoke the consent. I further understand that with the signing of the order of adoption
by the court I shall give up all my rights of custody, services, and earnings of said child and I may not reclaim said child.
Signed in the presence of:
SIGNATURE OF REPRESENTATIVE: CDSS or Delegated County Adoption Agency
DATE
CDSS DISTRICT OFFICE OR COUNTY OFFICE
SIGNATURE OF ALLEGED NATURAL FATHER
ADDRESS
FULL ADDRESS
TELEPHONE NUMBER
- - - OR - - State of
)
)
)
County of
On ____________________________________ before me, ____________________________________ , a Notary Public,
personally appeared ____________________________________ proved to me on the basis of satisfactory evidence to be
Name of Alleged Natural Father
the person whose name is subscribed to the within instrument and acknowledged to me that he executed the same in his
authorized capacity, and that by his signature on the instrument the person, or the entity upon behalf of which the person
acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and
correct.
WITNESS my hand and official seal.
________________________________________ (Seal)
Signature
*(NOTARIZE ONLY WHEN SIGNED OUTSIDE STATE OF CALIFORNIA.)
AD 594 (ENG/SP) (3/08)
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