Dorothy Brown, Clerk of the Circuit Court of Cook County, Illinoiscookcountyclerkofcourt.orgPage 1 of 1 Request for Notice to Putative Father þ (02/21/19) CCCO 0024 en-USIN THE CIRCUIT COURT OF COOK COUNTY, ILLINOISen-USCOUNTY DEPARTMENT, COUNTY DIVISIONen-USREQUEST FOR NOTICE TO PUTATIVE FATHER (0029) en-USIN THE MATTER OF NOTICE TO en-USPutative Father Address: þ þ City: þ þ State: þ þ Zip: þ en-US Case No. þ en-US states:en-USThe undersigned, in accordance with 750 ILCS 50/12a, of the Illinois Adoption Act, requests a notice to be sent to: þ en-US named as the father of a child born on þ or expected to be born on or about þ en-US . The mother of said child is þ en-US .en-USUnder penalties as provided by law pursuant to 735 ILCS 5/1-109 I certify that the statements set en-USen-USas to matters therein stated to be on information and belief, and as to such matters, I certify that I en-USbelieve the same to be true. en-USSignature Date: þ en-USen-USVERIFICATION BY CERTIFICATION