CHRIS KACHIROUBAS, CLERK OF THE 18th JUDICIAL CIRCUIT COURT 251 WHEATON, ILLINOIS 60187-0707 File Stamp Here3217-3 (Rev. 06/08)DECLARATION OF PATERNITY W/ENTRY OF APPEARANCE - PATERNITYPutative FatherDECLARATON OF PATERNITY WITH ENTRY OF APPEARANCECASE NUMBERIN THE MATTER OF NOTICE TO I, on oath state: 1. That I am years of age; that I reside at in the County of State of . 2. I hereby enter my appearance in the above mentioned cause. 3. That I have been advised that is the mother of a male female child named born or expected to be born on or about and that such mother has stated that I am the father of this child. 4. I declare that I am the father of this child.UNITED STATES OF AMERICA STATE OF ILLINOIS COUNTY OF DU PAGE IN THE CIRCUIT COURT OF THE EIGHTEENTH JUDICIAL CIRCUIT Signature 5. I further understand that the mother of this child wishes to consent to the adoption of the child. I do not consent to the the adoption of this child, and I understand that I must return this initial declaration of parentage form to the Clerk of Circuit Court, DuPage County Judicial Center, 505 N. County Farm Rd., Wheaton, Illinois 60187 within thirty (30) days of receipt of this notice. 6. I further understand that I am also obligated to establish my paternity pursuant to the Parentage Act of 1984, as amended, within thirty (30) days of my receiving this notice or, if the child in not yet born, within thirty (30) days after the birth of the child. This proceeding is separate and distinct from the above mailing of initial declaration of paternity in this second notice, I must state that I am, in fact, the father of said child, and that I intend to retain my legal rights with respect to said child, and request to be notified of any further proceedings with respect to custody or adoption of the child.OATH I have been duly sworn and I say under oath that I have read and understand this Declaration of Paternity with Entry of Appearance. The facts it contains are true and correct to the best of my knowledge, and I understand that by signing this document I admit paternity. I have signed this document as my free and voluntary act.Signed and sworn to before me DateCircuit Clerk or Notary Public American LegalNet, Inc. www.FormsWorkFlow.com