STATE OF ILLINOIS) )SS COUNTY OF WILL ) IN THE CIRCUIT COURT OF THE TWELFTH JUDICIAL COURT WILL COUNTY, ILLINOIS IN THE MATTER OF: NOTICE: ___________________________________, Putative Father NOTICE TO PUTATIVE FATHER (By Certified Mail) You have been identified as the father of a child_____________________________________________________, (Born or Expected to be born on or about) __________________________, 20____. The mother of said child is______________________________________________________________________. The mother has indicated that she intends to place the child for adoption. As the alleged father of said child, you have certain legal rights with respect to said child, including the right to notice of the filing of 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 Clerk of this Circuit Court of Will County, Illinois, whose address is 14 West Jefferson Street, Room 212, Joliet, Illinois 60432, within 30 days after the date of receipt of this notice, a declaration of paternity 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, or request to be notified of any further proceedings with respect to custody or adoption of the child. If you do not file such a declaration of paternity or a request for notice then whatever legal rights you have with respect to said child, including the right to notice or any further 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 proceeding instituted for the adoption of said child. If you are not the father of said child, you may file with the Clerk of this Court a disclaimer of paternity which will be noted in the Clerk’s file and you will receive no further notice with respect to said child. Dated___________________________, 20____. _____________________________________________ PAMELA J. MCGUIRE, Clerk of the Circuit Court DECLARATION OF PATERNITY I hereby declare that I am, in fact, father of said child and wish to retain my parental rights. I request notice in the event of a hearing brought to terminate any rights I may have in regards to said child. Signed and sworn to before me _________________________________, 20____. ________________________________________ (Signature) ______________________________________________________ (Signature of Official) ______________________________________________________ (Address) _______________________________________________________ ______________________________________________________ (Official Capacity) American LegalNet, Inc. www.FormsWorkflow.com DISCLAIMER OF PATERNITY I deny and disclaim that I am the father of said child and waive any rights I may have to said child. Signed and sworn to before me ________________________________, 20____. ________________________________________ (Signature) _______________________________________________________________________________ (Signature of Official) (Address) ________________________________________________________________________________ (Official Capacity) REQUEST FOR NOTICE I request notice in event of a hearing brought to terminate any rights I may have in regards to said child. ________________________________________ (Signature) __________________________________________________________________________________ (Signature of Official) (Address) Dated ___________________________, 20_____ American LegalNet, Inc. www.FormsWorkflow.com