DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOISPage 1 of 1 Consent of a Person Aged Fourteen or Older þ (04/04/19) CCCO 0004 en-USIN THE CIRCUIT COURT OF COOK COUNTY, ILLINOISen-USCOUNTY DEPARTMENT, COUNTY DIVISION en-USIN THE MATTER OF THE PETITION OF en-USand en-USTo Adopt: en-USa minor(s) Case No. þ en-USen-USCONSENT OF A PERSON AGED FOURTEEN OR OLDER (2721) I,þ en-US , state: 1. I live at þ , City/Town of þ en-US , County of þ , and State of en-US . 2. My age is þ en-US years. 3. I consent and agree to my adoption by þ en-US and þ en-US . 4. I further consent and agree to the change of my name to þ . þ have my name remain as it is. en-USI hereby waive service of summons and enter my appearance in these proceedings. Dated: þ þ Signature þ I, þ en-US , a Judge of the Circuit Court of Cook County, Illinois, dohereby certify that þ en-US , personally known to me to be the same person en-USwhose name is signed on the foregoing consent, and that s/he appeared before me this day in person and en-USacknowledged that s/he signed and delivered this consent as his/her free and voluntary act, for the purpose en-US þ en-US .en-US þ þ Judge þ Judge222s No.