JDF 480 R 3 / 1 8 BIRTH PARENT AFFIDAVIT FOR EXPEDITED RELINQUISHMENT Page 1 of 2 District Court Denver Juvenile Court County, Colorado Court Address: I n the Matter of the Petition of : And Petitioner(s) F or the Relinquishment of a Child , COURT USE ONLY Attorney or Party Without Attorney (Name and Address): Phone Number: E - mail: FAX Number: Atty. Reg. #: Case Number: Division Courtroom BIRTH PARENT AFFIDAVIT FOR EXPEDITED RELINQUISHMENT The Petitioner(s) , being first duly sworn, state the following: 1. I/we am/are the biological parent(s) of: a child expected to be born on or about (date). a child born on (date), in (city/state) whose name is . 2. I/we desire to voluntarily relinquish the parent - child legal relationship with said child through an expedited relinquishment process without the necessity of a personal appearance at a court hearing. 3. I/we understand I/we may sign this affidavit before the birth of said child. 4. I/we consent to waive any righ t to contest a termination of parental rights. 5. Said child will be under one year of age at the time of filing the attached Petition for Relinquishment. 6. I/we have been assisted by , a licensed child placement agency o r county department of social services in the county where I/we reside. 7. I/we understand the consequences of the relinquishment decision which may include but not be limited to: The irrevocable termination of the right to parent the child. No further parental responsibility for the child. The decision is complete and final. Any open adoption agreement that has been entered into with an adoptive family cannot legally be enforced in the State of Colorado. I/we may not inherit from the child , and the child may not inherit from me/us once the adoption is final. 8. I/we understand I/we am/are required to obtain relinquishment counseling from a licensed child placement agency or a county department of social services. 9. I/we have completed the requ ired relinquishment counseling, or understand that I/we must complete the required counseling prior to the court entering a Final Order of Relinquishment. American LegalNet, Inc. www.FormsWorkFlow.com JDF 480 R 3 / 1 8 BIRTH PARENT AFFIDAVIT FOR EXPEDITED RELINQUISHMENT Page 2 of 2 10. I/we understand I/we have the right to seek additional, independent counseling. 11. I/we have waived t he right to request legal counsel prior to signing this Affidavit. 12. I/we understand that I/we may withdraw this Affidavit anytime after signing it, but before the Affidavit and Petition for Relinquishment are filed with the Court. I/we understand that the Affidavit and Petition for Relinquishment may not be filed with the Court until at least four days after the birth of the child. 13. This relinquishment decision is knowing and voluntary and not the result of any threats, coercion, or undue influence or ind ucement. 14. I/we believe this relinquishment is in the best interests of the child. By checking this box, I /we a re acknowledging we a re filling in the blanks and not changing anything else on the form. By checking this box, I /we are acknowledging that we have made a change to the original content of this form. VERIFICATION I declare under penalty of perjury under the law of Colorado that the foregoing is true a nd correct. Executed on the day of , , at (date) (month) (year) (city or other location, and state OR country ( P rinted name of Petitioner) Signature of Petitioner Witness #1: Witness # 2 : Agency/County Representative Date Date Relationship to Affiant I declare under penalty of perjury under the law of Colorado that the foregoing is true and correct. Executed on the day of , , at (date) (month) (year) (city or other location , and state OR country ( P rinted name of Co - Petitioner) Signature of Co - Petitioner Witness #1: Witness #2: Agency/County Representative Date Date Relationship to Affiant American LegalNet, Inc. www.FormsWorkFlow.com