Consent Of A Person Aged Fourteen Or Older
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Consent Of A Person Aged Fourteen Or Older Form. This is a Illinois form and can be use in Cook Local County.
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Tags: Consent Of A Person Aged Fourteen Or Older, CCCO 0004, Illinois Local County, Cook
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Consent of a Person Aged Fourteen or Older
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(Rev. 10/05/07) CCCO 0004
(This form replaces CCO-12)
IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS
COUNTY DEPARTMENT, COUNTY DIVISION
IN THE MATTER OF THE PETITION OF
_________________________________________________
and
_________________________________________________
TO ADOPT:
_________________________________________________
}
No. ___________________________
CONSENT OF A PERSON AGED FOURTEEN OR OLDER (2721)
I, _____________________________________________________, state:
1. I reside at _____________________________________________________________________________, County
of _______________________________, and State of _____________________________.
2. My age is ___________ years.
3. I consent and agree to my adoption by _____________________________________________________
and _____________________________________________________________________________________________.
4. I further consent and agree to the change of my name to __________________________________________
__________________________________________________________________________________________________________.
5. I hereby waive service of summons and enter my appearance in these proceedings.
Dated: _________________________________, ________
________________________________________________
(Signature of minor)
I, _________________________________________________, a Judge of the Circuit Court of Cook County,
Illinois, do hereby certify that ______________________________________________________________, personally
known to me to be the same person whose name is signed on the foregoing consent, and that s/he appeared before
this day in person and acknowledged that s/he signed and delivered this consent as his/her free and voluntary act,
for the purpose specified in it.
In witness whereof, I have affixed my signature to this document on this _______________ day of
________________________________, _________
_________________________________________
Judge
Judge's No.
(COURT SEAL)
DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS
