Dorothy Brown, Clerk of the Circuit Court of Cook County, Illinoiscookcountyclerkofcourt.orgPage 1 of 2 2769 - Declaration of Paternity With Entry of Appearance þ (02/21/19) CCCO 0025 A en-USIN THE CIRCUIT COURT OF COOK COUNTY, ILLINOISen-USCOUNTY DEPARTMENT, COUNTY DIVISIONen-USI, þ en-US en-USstate as follows: 1. en-UST hat I am þ en-US years of age; that I reside at en-US , in the County of þ , State of þ en-US . 2. That I have been advised that þ en-US is the mother of a þ male þ female þ child, with the initials þ born on þ en-US , en-USor expected to be born on or about þ en-US , and that such mother has stated that I am the father of en-USthis child. 3. en-USI am the father of this child. en-USI further understand that the mother of this child wishes to consent to the adoption of the child.en-USI do not consent to the en-USadoption of this child. 5. en-USI understand that in order to establish my parental rights in this child, I must do both of theen-USfollowing: a. en-USI must return this Declaration of Paternity with Entry of Appearance form to the Clerk ofb. en-USI must initiate a separate action to establish my paternity of this child pursuant to theen-USParentage Act of 2015 (750 ILCS 46/101 it seq.) within 30 days of my receiving this notice,en-USor if the child is not yet born, within 30 days after the birth of the child. Note: þ en-USof the child222s birth in order to establish parental rights in the child. For information call 866-737-3237. en-USIN THE MATTER OF NOTICE TO en-USPutative Father Address: þ City: þ þ State: þ þ Zip: þ en-US Case No. þ Dorothy Brown, Clerk of the Circuit Court of Cook County, Illinoiscookcountyclerkofcourt.orgPage 2 of 2 6. en-USI hereby enter my appearance in the above entitled cause, and request notice of the birth of the child, and dateen-USof birth if not yet born. 2769 - Declaration of Paternity With Entry of Appearance þ (02/21/19) CCCO 0025 B en-USUnder penalties for perjury provided by Section 1-109 of the Code of Civil procedure I state that I have read and en-USunderstand this Declaration of Paternity with Entry of Appearance. The facts that it contains are true and correct en-USto the best of my knowledge, and I understand that by signing this document I admit paternity. I have signed this en-USdocument as my free and voluntary act.en-USOATH en-USSignature en-USSignature en-USPrinted Name