IN THE CIRCUIT COURT OF THE TWENTY-THIRD JUDICIAL CIRCUIT DEKALB COUNTY, ILLINOIS _______________________________________________ _______________________________________________ Petitioner(s), vs. _______________________________________________ _______________________________________________ Respondent(s). ) ) ) ) ) ) ) ) ) ) CASE NO. ______________________________ CONSENT TO ADOPTION OF ADULT I, ______________________________________________________________, father/mother of _______________________________, an adult, state: That I reside at __________________________________________________________, County of_____________________________ and State of _______________________________________. That I am of the age of __________ years. That I hereby enter my appearance in this proceeding and waive service of summons on me. That I do hereby consent and agree to the adoption of such adult by _______________________________________________________ and _________________________________________________. Dated this__________ day of __________________________, 20_____. STATE OF ILLINOIS ) ) SS. COUNTY OF ___________________ ) _______________________________________________ I,__ ________________________________________________________________________________________, do hereby certify that (Name and Official Capacity) ________________________________________ personally known to me to be the same person whose name is subscribed to the foregoing consent, appeared before me this day in person and acknowledged that he/she signed and delivered such consent as his/her free and voluntary act, for the specified purpose. I have fully explained that by signing such consent he/she is irrevocably relinquishing all parental rights to such adult and he/she has stated that such is his/her intention or desire. IN WITNESS WHEREOF, I have hereunto affixed my signature this ___________ day of _____________________, 20_______. _______________________________________________ _______________________________________________ STATE OF ILLINOIS ) ) SS. COUNTY OF ___________________ ) I, ____________________________________________________, a Notary Public in and for said County, in the State aforesaid, do hereby certify that the same person whose name is subscribed to the foregoing certificate of acknowledgment, appeared before me this day in person and acknowledged that he/she signed such certificate as his/her voluntary act and that the statements made in said certificate are true. Given under my hand and notarial seal this ___________ day of _____________________, 20_______. (Official Seal) _______________________________________________ Notary Public Consent to Adoption of Adult Rev. 04-01-2016 American LegalNet, Inc. www.FormsWorkFlow.com