IN THE CIRCUIT COURT OF THE NINETEENTH JUDICIAL CIRCUIT LAKE COUNTY, ILLINOIS ) ) ) ) ) ) ) ) to adopt No. ________AD _____________ CERTIFICATE OF GUARDIAN AD LITEM ______________________________, as Guardian Ad Litem for the child(ren) sought to be adopted in this proceedings and as an Officer of the Court, certifies and represents to the Court as follows: I have prior to the hearing for entry of Judgment of Adoption reviewed the Court file in this matter and determined the following, in accord with 750 ILCS 50/0.01 et seq (Adoption Act): 1. That all parties named in the Petition, other than the Petitioners, have been properly served as required by the Adoption Act, or have signed a Consent or a Surrender. 2. That any Consent to adoption was properly taken pursuant to the law of this State, 750 ILCS 50/ 10 (H) and (I), or, if taken in another State, was taken pursuant to the laws of that State. 3. That, when required by 750 ILCS 50/11, the mother of the child has filed herein an Affidavit of Identification identifying the father of the child. 4. That the Petition is in proper form and states an action for adoption as required by the Adoption Act, including, if necessary, allegations as to unfitness of a parent and/or allegations as to any putative father to establish that a Consent from him is not required. 5. That all persons who are not parties but who are entitled to notice and an opportunity to be heard under the Adoption Act of this State have received proper notice. 6. If the child is not related to the Petitioners as defined in the Adoption Act, the following documents have been filed: a Home Study prepared by a licensed Illinois child welfare agency, a criminal background check including fingerprint clearances as required by the Adoption Act, and all affidavits required by statute as to payment of monies. 7. If the child is under the Guardianship of a licensed child welfare agency or the Department of Children and Family Services (DCFS), that the child welfare agency or DCFS has been named as a Respondent in the Petition and has entered its Appearance and Consent to the adoption, and (A) If the child’s parent(s) surrendered their parental rights to DCFS or a licensed child welfare agency, that copies of those Surrenders are on file, (B) If the parental rights of the child’s parent(s) have been terminated by a Court order, that copies of those Order(s) are on file and appear on their face to be properly entered. 8. If any party was served by publication, that adequate attempts were undertaken to notify the party before resort was made to publication and that publication was made as required by the Adoption Act. 9. If the child sought to be adopted was born out of wedlock and/or if any father named in the Affidavit of Identification has not consented or surrendered his parental rights, that a search of the Putative Father Registry of the State of Illinois has been made and is in the Court file and reveals no person has so registered. _________________________ Date ______________________________________ Guardian Ad Litem American LegalNet, Inc. www.USCourtForms.com 171-346 (12/04)