Rule 17.200--Form 212: Joint Statement on Legal Parent · The parties use this form if a child is born or conceived during the marriage and both parties want the court to find that one of the parties is not a legal parent of the child. Note: For purposes of this form, legal parent is a person who is recognized by law as a parent to a child because of marriage. · This form tells the court that both parties agree that one party is not a biological parent and should be disestablished as (should no longer be) a legal parent of the child. · This form can only be used if the party being disestablished is a legal parent of the child because of the marriage of the parties and there is a pending dissolution of marriage action in Iowa. Do not use this form if the party being disestablished is a legal parent of the child because of an affidavit, court order, or action in another state. If you do not understand how to use this form, or if you should use this form, talk to an attorney. In the Iowa District Court for County where your case is filed County Upon the Petition of Equity case no. Petitioner Full name first, middle, last Joint Statement on Legal Parent and concerning Respondent Full name first, middle, last 1. Legal Parent Check each that applies. A. Petitioner's or Respondent's name is a legal parent but not a biological parent of . Expected due date Petitioner's or Respondent's unborn child expected to be born B. Petitioner's or Respondent's name is a legal parent but not a biological parent of the following children born during the marriage: List children's initials and birth year First, middle, & last initials of each child (1) (2) (3) Birth year First, middle, & last initials of each child (4) (5) (6) Check this box if you have attached a sheet listing additional children for whom Petitioner or Respondent is not a biological parent. Birth year Continued on next page March 2014 Rule 17.200--Form 212 Page 1 of 3 American LegalNet, Inc. www.FormsWorkFlow.com Rule 17.200--Form 212: Joint Statement on Legal Parent, continued 2. Biological Parent The biological parents, if known, of the children are as follows: First, middle, & last initials of each child (1) (2) (3) Biological parent First, middle, & last initials of each child (4) (5) (6) Biological parent 3. Best Interests of the Children It is in the best interests of the children and the parties that Petitioner's or Respondent's name is found not to be a legal parent of the child or children. 4. Guardian Ad Litem We understand that the court may appoint a guardian ad litem (an attorney) for the child or children, and that we may have to pay the costs of the guardian ad litem. 5. Request We ask the court to find and conclude that the legal parent, Petitioner's or Respondent's name is not a biological parent of the child or children, including any unborn child, listed in section 1 above, and that the court disestablish that person as a legal parent of the child or children. 6. Attorney Help A. Petitioner (1) (2) Check one An attorney did not help me prepare or fill in this paper. An attorney helped me prepare or fill in this paper. If you check (2), you must fill in the following information: Name of attorney or organization, if any Business address of attorney or organization Attorney's P.I.N. # ­ Ask the attorney City State ZIP code ( ) ( ) Attorney's email address ­ optional Attorney's phone number Attorney's fax number ­ optional Continued on next page March 2014 Rule 17.200--Form 212 Page 2 of 3 American LegalNet, Inc. www.FormsWorkFlow.com Rule 17.200--Form 212: Joint Statement on Legal Parent, continued B. Respondent (1) (2) Check one An attorney did not help me prepare or fill in this paper. An attorney helped me prepare or fill in this paper. If you check (2), you must fill in the following information: Name of attorney or organization, if any Business address of attorney or organization Attorney's P.I.N. # ­ Ask the attorney City State ZIP code ( ) ( ) Attorney's email address ­ optional Attorney's phone number Attorney's fax number ­ optional 7. Oaths and Signatures A. Petitioner's Oath and Signature I, , have read this Joint Statement, and I certify under penalty of Print your name perjury and pursuant to the laws of the State of Iowa that the information I have provided in this Joint Statement is true and correct. , 20 Month Day Year Petitioner's signature* Mailing address City State ZIP code ( ) Email address Additional email address ­ if available Phone number * Whether filing electronically or in paper, you must handwrite your signature on this form. If you are filing electronically, scan the form after signing it and then file electronically. B. Respondent's Oath and Signature , have read this Joint Statement, and I certify under penalty of Print your name perjury and pursuant to the laws of the State of Iowa that the information I have provided in this Joint Statement is true and correct. I, , 20 Month Day Year Respondent's signature* Mailing address City State ZIP code ( ) Email address Additional email address ­ if available Phone number * Whether filing electronically or in paper, you must handwrite your signature on this form. If you are filing electronically, scan the form after signing it and then file electronically. March 2014 Rule 17.200--Form 212 Page 3 of 3 American LegalNet, Inc. www.FormsWorkFlow.com