CHRIS KACHIROUBAS, CLERK OF THE 18th JUDICIAL CIRCUIT COURT 251 WHEATON, ILLINOIS 60187-0707 on oath state that in accordance with Illinois Adoption Act 750 ILCS 50/12a request a notice to be sent to: Name Address City StateZip (print only) File Stamp Here3216 (Rev. 4/18)REQUEST FOR NOTICE TO PUTATIVE FATHER - PATERNITYCASE NUMBER I further certify that the address shown is the last know address of the putative father.REQUEST FOR NOTICE TO PUTATIVE FATHER AFFIDAVIT FOR: FATHER IDENTIFICATION LAST KNOW ADDRESSIN THE MATTER OF NOTICE TO Identified as the father of a child born on or expected to be born on or about The mother of said child is UNITED STATES OF AMERICASTATE OF ILLINOIS COUNTY OF DU PAGE IN THE CIRCUIT COURT OF THE EIGHTEENTH JUDICIAL CIRCUITPutative Father Signed and sworn to before meSignature DateCircuit Clerk or Notary Public To: Chris Kachiroubas, Clerk of the Eighteenth Judicial Circuit Court, DuPage County, IllinoisName: DuPage Attorney Number: Attorney for: Address: City/State/Zip: Telephone Number: Pro SeEmail: American LegalNet, Inc. www.FormsWorkFlow.com