CHECKLIST Petition To Voluntarily Relinquish Parental Rights – To Agency 23 Pa. C.S.A. § 2501 Rule 15.2 (Documents to be attached to the Petition in the order they appear): _____ Preliminary Decree – Rule 15.1A(4) _____ Final Decree _____ Important Notice – 23 Pa. C.S.A. 2513(b) _____ Petition to Voluntarily Relinquish Parental Rights ___ ___ ___ ___ Attorney Caption Signed by Attorney or Petitioner Verified by Petitioner Petitioner is Relinquishing Birth Parent _____ Joinder of a parent who is not a petitioner or his or her waiver of all interest in the child if either is obtainable, if not explain why not. - Rule 15.2(b)(1) _____ Consent of a parent or guardian of a petitioner who has not reached 18 years old. – Rule 15.2(b)(3) _____ Joinder and consent of Agency to accept custody of the child – Rule 15.2(b)(4) _____ Original Long Form Birth Certificate – Rule 15.2(b)(2) _____ Out-of-County Decrees Certified _____ Foreign Documents Translated _____ Notice(s) Pursuant to 23 Pa.C.S.A. §2513(b) ____ at least ten (10) days notice by personal service, OR ____ Registered Mail, OR ____ By such means as the Court may require (See, Pa.R.C.P. 430) ____ Proof of Notice(s) – to be filed at or before the hearing NOTE: PETITIONER'S PRESENCE IS REQUIRED AT HEARING American LegalNet, Inc. www.USCourtForms.com