Print Form Notice to Putative Father Clear Form (Rev. 9/21/07) CCCO 0023 IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS COUNTY DEPARTMENT, COUNTY DIVISION IN THE MATTER OF NOTICE TO ____________________________________________________ PUTATIVE FATHER ____________________________________________________ (Street) ____________________________________________________ (City) (State) (Zip) } No. _________________________________ You have been identified as the father of a child born on the ________ day of __________________________, ________ or expected to be born on the _________ day of ____________________, ________. The mother of said child is __________________________________________. NOTICE TO PUTATIVE FATHER (2871) 750 ILCS 50/12a The mother has indicated that she intends to place the child for adoption. As a named father of said child, you have certain legal rights with respect to said child, including the right to notice of the filing of the proceedings instituted for the adoption of said child. IF YOU WISH TO RETAIN YOUR RIGHTS with respect to said child you must file with the the Clerk of the Circuit Court of Cook County, Illinois, whose address is Room 1202, Richard J. Daley Center, Chicago, Illinois 60602, within 30 days after the date of receipt of this notice, the DECLARATION OF PATERNITY enclosed herewith stating that you are, in fact, the father of said child, and that you intend to retain your legal rights with respect to said child, and request to be notified of any further proceeding with respect to custody or adoption of the child. You must also initiate action to establish paternity pursuant to the Parentage Act of 1984 within 30 days of your receiving this notice; or, if the child is not yet born, within 30 days after the birth of the child. If you do not file such a declaration of paternity, and request for notice, and you do not initiate action to establish paternity as stated above, then whatever legal rights you have with respect to said child, including the right to notice of any future proceedings for the adoption of said child, may be terminated without any further notice to you. When your legal rights with respect to said child are so terminated, you will not be entitled to notice of any proceedings institued for the adoption of said child. IF YOU DENY YOU ARE THE FATHER OF SAID CHILD, you may file with the Clerk of the Court the DENIAL OF PATERNITY enclosed herewith, which will be noted in the Clerk's file, and you will receive no further notice with respect to said child. ____________________________________________________ Clerk of the Circuit Court Date DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS