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Affidavit Of Waiver Of All Parental Rights Relinquishment Of Child And Consent To Adoption (Sample And Form) Form. This is a Montana form and can be use in District Court Statewide.
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Tags: Affidavit Of Waiver Of All Parental Rights Relinquishment Of Child And Consent To Adoption (Sample And Form), Montana Statewide, District Court
COURT
COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
......... ..
:
Index No.
:
1 Name
Address
2 Phone Number
Plaintiff(s)
-against-
Calendar No.
:
JUDICIAL SUBPOENA
:
:
3
:
4
Defendant(s)
:
5. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6
THE PEOPLE OF THE STATE OF NEW YORK
7
TO MONTANA [DISTRICT NUMBER] JUDICIAL DISTRICT COURT, [COUNTY NAME]
8
COUNTY
9
GREETINGS:
IN THE MATTER OF THE ADOPTION OF
Cause No.
_______________
10
WE COMMAND YOU, that all business and excuses AFFIDAVIT OF WAIVER OF attend before
being laid aside, you and each of you
,
the[NAME OF MINOR CHILD],
Honorable
at the
Court
11
ALL PARENTAL RIGHTS,
located at
County of
A minor child,
RELINQUISHMENT OF CHILD,
, on the
day of
, 20
, at
o'clock in the
noon, and at any recessed
12in room
AND CONSENT TO ADOPTION
or adjourned date, to testify and give evidence as a witness in this action on the part of the
by
13
[NAME OF PETITIONER],
14
Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to
the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a
Petitioner.
15result of your failure to comply.
Witness, Honorable
STATE
)
Court in OF ________________day of
County,
, one of the Justices of the
16
17
County of _________________
18
, 20
: ss
)
(Attorney must sign above and type name below)
1.
I, [NAME OF RELINQUISHING PARENT], first being duly sworn, state the
19
following:
20
2.
Attorney(s) for
I am the [natural father]/ [natural mother] of the minor child, [NAME OF MINOR
21
CHILD], who was born on [DATE OF BIRTH OF MINOR CHILD] in [PLACE OF BIRTH OF
22
Office and P.O. Address
MINOR CHILD]. (§ 42-2-412(1)(c), MCA) I am over 18 years of age. I was born on
23
Telephone No.:
Facsimile No.:
24
E-Mail Address:
Mobile Tel. No.:
Affidavit of Waiver of All Parental Rights, Relinquishment of Child, & Consent to Adoption
Page 1
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COURT
COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
......... ..
:
:
Index No.
Calendar No.
:
1 _________ ____, 19__. My current mailing address is [ADDRESS, CITY, STATE, ZIP OF
JUDICIAL SUBPOENA
Plaintiff(s)
-against2 RELINQUISHING PARENT]. (§ 42-2-412(1)(b), MCA) :
3
3.
After carefully considering the best interests :of my minor child, I hereby
:
4 relinquish care, custody, and control of the minor child to her MOTHER/FATHER, [NAME OF
Defendant(s)
:
........................ ........... ..... ...... ..
5. .STEPPARENT'S SPOUSE],. [ADDRESS,.CITY,. STATE. OF RESIDENCE OF
6 STEPPARENT'S SPOUSE] and to [NAME OF STEPPARENT], (§ 42-2-412(1)(d), MCA),
THE PEOPLE OF THE STATE OF NEW YORK
7 who resides at [ADDRESS, CITY, STATE OF RESIDENCE OF STEPPARENT] (§ 42-2TO
8 412(1)(d), MCA)
9
4.
By signing this document, I understand that I am relinquishing all of my parental
GREETINGS:
10 rights to the minor child, [NAME OF MINOR CHILD]. My relinquishment is voluntary,
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
,
the Honorable and is given freely with a clear mind. I have not been unduly influenced by anyone
at the
Court
11 irrevocable,
located at
County of
room
, on the
day
, 20
, at
o'clock in the
noon, and at any recessed
12inin making this relinquishment. of
or adjourned date, to testify and give evidence as a witness in this action on the part of the
13
5.
I knowingly, unequivocally, and voluntarily transfer permanent legal and physical
Your failure to mother, [NAME OF STEPPARENT'S a contempt of court and will make you liable to
14 custody to the child’scomply with this subpoena is punishable asSPOUSE], and [NAME OF
the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a
15result of your failure (§ 42-2-412(2)(b), MCA)
STEPPARENT]. to comply.
16
Witness, Honorable unequivocally, and voluntarily give my consent to have anyof the of
, one of the Justices court
6.
I knowingly,
Court in
County,
day of
, 20
17 competent jurisdiction terminate my parental rights and award permanent legal custody with the
18 right to consent to adoption to the child’s mother. (§ 42-2-412(2)(b), sign above and type name below)
(Attorney must MCA)
19
7.
I knowingly, unequivocally, and voluntarily give my consent to have [NAME OF
Attorney(s) for
20 STEPPARENT] adopt the minor child, [NAME OF MINOR CHILD], (§ 42-4-301(1); 42-221 402(1)(b)), who resides at [ADDRESS, CITY, STATE OF RESIDENCE OF STEPPARENT] (§
22 42-2-412(1)(d), MCA)
23
8.
Office and P.O. Address
I understand that upon my signature of this document, it is final and may not be
Telephone No.:
Facsimile No.:
24 revoked or set aside for any reason, including failure of an adoptive parent to permit me to visit
E-Mail Address:
Mobile Tel. No.:
Affidavit of Waiver of All Parental Rights, Relinquishment of Child, & Consent to Adoption
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COURT
COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
......... ..
:
:
Index No.
Calendar No.
:
1 or communicate with the child, except as provided for in Section 42-2-411, MCA. (§ 42-2JUDICIAL SUBPOENA
Plaintiff(s)
-against-
2 412(3)(a), MCA)
3
9.
:
:
I understand that, upon the adoption of this minor child, all of my parental rights
:
4 and obligations with respect to the minor child, [NAME OF MINOR CHILD], will be
Defendant(s)
:
........... ..... .. ......... .. .... ...... .....
5. .extinguished,.except. for. arrearages .for .child .support .unless .waived. (§ 42-2-412(3)(b), MCA)
6
10.
I understand that this relinquishment will remain valid whether or not any
THE PEOPLE OF THE STATE OF NEW YORK
7 agreement for visitation or communication with the child is later performed. (§ 42-2-412(3)(b),
TO
8 MCA)
9
11.
I have not been offered any money or anything of value for execution of this
GREETINGS:
10 document. (§ 42-2-412(3)(e)(ii), MCA)
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
,
the Honorable I expressly waive my rights to notice of proceedings regarding this child,
at the
Court
11
12.
located at
County of
room
, on the
day of
,
, at
o'clock in the
noon, and at any
12inincluding any hearing terminating my parental 20
rights and awarding permanent legal custody to recessed
or adjourned date, to testify and give evidence as a witness in this action on the part of the
13 the child’s mother and [NAME OF STEPPARENT]. (§ 42-2-412(4), MCA)
14
Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to
13.
I further waive my right to notice of any adoption proceeding and expressly
the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a
15result of your failure to comply.
consent that any adoption proceeding may be heard at any time without notice to me. (§ 42-2-
16 412(4), Witness, Honorable
MCA)
Court in
17
County,
14.
, one of the Justices of the
day of
, 20
I acknowledge that I have received a copy of this document. (§ 42-2-412(3)(c)(i),
18 MCA)
(Attorney must sign above and type name below)
19 DATED this _______ day of ________________ , 20 _______.
Attorney(s) for
20 Executed at ___________________________________ at _______ o’clock _____. m.
(location)
21 (§ 42-2-412(1)(a), MCA)
22
Office and P.O. Address
___________________________________
[NAME OF RELINQUISHING PARENT]
23
Relinquishing Parent
Telephone No.:
Facsimile No.:
24
E-Mail Address:
Mobile Tel. No.:
Affidavit of Waiver of All Parental Rights, Relinquishment of Child, & Consent to Adoption
Page 3
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COURT
COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
......... ..
:
:
Index No.
Calendar No.
1 SUBSCRIBED AND SWORN TO before me this __ day of: ___________ , 20__ by [NAME OF
JUDICIAL SUBPOENA
Plaintiff(s)
RELINQUISHING PARENT].
-against:
2
__________________________________________
:
Notary's Signature
3
Notary Public for the State of _________________
:
4
Printed
Defendant(s) name of notary _______________________
:
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Title . . .rank: . ______________________________
. . . . or . . . . .
5
Residing at _______________________________
My Commission Expires: ____________________
6
THE PEOPLE OF THE STATE OF NEW YORK
7
TO
8 (Seal)
9
GREETINGS:
10
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
,
the Honorable
at the
Court
11
located at
County of
, on the
day of
, 20
, at
o'clock in the
noon, and at any recessed
12in room
or adjourned date, to testify and give evidence as a witness in this action on the part of the
13
14
Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to
the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a
15result of your failure to comply.
Witness, Honorable
Court in
County,
, one of the Justices of the
16
day of
, 20
17
18
(Attorney must sign above and type name below)
19
20
Attorney(s) for
21
22
Office and P.O. Address
23
Telephone No.:
Facsimile No.:
24
E-Mail Address:
Mobile Tel. No.:
Affidavit of Waiver of All Parental Rights, Relinquishment of Child, & Consent to Adoption
Page 4
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COURT
COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
......... ..
:
Index No.
:
1 Name
Address
2 Phone Number
Plaintiff(s)
-against-
Calendar No.
:
JUDICIAL SUBPOENA
:
:
3
:
4
Defendant(s)
:
5. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6
THE PEOPLE OF THE STATE OF NEW YORK
7
TO MONTANA
JUDICIAL DISTRICT COURT,
COUNTY
8
9
GREETINGS:
IN THE MATTER OF THE ADOPTION OF
Cause No.
_______________
10
WE COMMAND YOU, that all business and excuses AFFIDAVIT OF WAIVER OF attend before
being laid aside, you and each of you
,
the Honorable
at the
Court
11
ALL PARENTAL RIGHTS,
located at
County of
A minor child,
RELINQUISHMENT OF CHILD,
, on the
day of
, 20
, at
o'clock in the
noon, and at any recessed
12in room
AND CONSENT TO ADOPTION
or adjourned date, to testify and give evidence as a witness in this action on the part of the
by
13
14
Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to
the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a
Petitioner.
15result of your failure to comply.
Witness, Honorable
STATE
)
Court in OF ________________day of
County,
, one of the Justices of the
16
17
County of _________________
, 20
: ss
)
18
(Attorney must sign above and type name below)
1.
I,
, first being duly sworn, state the
19
following:
Attorney(s) for
20
2.
I am the natural
of the minor child,
21
who was born on
22
in
Office and P.O. Address
I am over 18 years of age. I was born on
23
Telephone No.:
Facsimile No.:
24
E-Mail Address:
Mobile Tel. No.:
Affidavit of Waiver of All Parental Rights, Relinquishment of Child, & Consent to Adoption
Page 1
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COURT
COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
......... ..
:
Index No.
:
1 _________ ____, ____. My current mailing address is
Plaintiff(s)
2
Calendar No.
:
JUDICIAL SUBPOENA
-againstAfter carefully considering the best interests :of my minor child, I hereby
3.
:
3 relinquish care, custody, and control of the minor child to her MOTHER/FATHER,
:
4
Defendant(s)
:
. . . to
5. . . . . . . . . . . . . . . . . . . . . . . .and . . . . . . . . . . . . . . . . . . . . . . . . . . .
6 who resides at
THE PEOPLE OF THE STATE OF NEW YORK
7
4.
By signing this document, I understand that I am relinquishing all of my parental
TO
8 rights to the minor child,
. My relinquishment is voluntary,
9 irrevocable, and is given freely with a clear mind. I have not been unduly influenced by anyone
GREETINGS:
10 in making this relinquishment.
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
,
the Honorable knowingly, unequivocally, and voluntarily transfer Court
at the
11
5.
I
permanent legal and physical
located at
County of
room
, on the
day
, 20
, at
noon, and at any recessed
, and o'clock in the
12incustody to the child’s mother, of
or adjourned date, to testify and give evidence as a witness in this action on the part of the
13
6.
I knowingly, unequivocally, and voluntarily give my consent to have any court of
Your failure to comply with this subpoena is punishable as contempt legal custody make you
14 competent jurisdiction terminate my parental rights and awardapermanentof court and willwith the liable to
the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a
15result of your failure to comply.to the child’s mother.
right to consent to adoption
16
, one have
7. Witness, Honorable
I knowingly, unequivocally, and voluntarily give my consent toof the Justices of the
Court in
17
County,
, 20
adopt the minor child,
18 who resides at
19
day of
8.
(Attorney must sign above and type name below)
I understand that upon my signature of this document, it is final and may not be
Attorney(s) for
20 revoked or set aside for any reason, including failure of an adoptive parent to permit me to visit
21
22
Office and P.O. Address
23
Telephone No.:
Facsimile No.:
24
E-Mail Address:
Mobile Tel. No.:
Affidavit of Waiver of All Parental Rights, Relinquishment of Child, & Consent to Adoption
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COURT
COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
......... ..
:
:
Index No.
Calendar No.
:
1 or communicate with the child, except as provided for in Section 42-2-411, MCA.
JUDICIAL SUBPOENA
Plaintiff(s)
2
9.
-against:
I understand that, upon the adoption of this minor child, all of my parental rights
:
3 and obligations with respect to the minor child,
, will be
:
4 extinguished, except for arrearages for child support unless waived.
Defendant(s)
:
...
......... ... ... ............ ... ...
5. . . . . . . . 10. . . . .I. understand. that .this .relinquishment. will. remain valid whether or not any
6 agreement for visitation or communication with the child is later performed.
THE PEOPLE OF THE STATE OF NEW YORK
7
11.
I have not been offered any money or anything of value for execution of this
TO
8 document.
9
12.
I expressly waive my rights to notice of proceedings regarding this child,
GREETINGS:
10 including any hearing terminating my parental rights and awarding permanent legal custody to
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
,
the Honorablemother and
at the
Court
11 the child’s
located at
County of
on the
day of
, 20
, at
o'clock in the
I, further waive my right to notice of any adoption proceeding and noon, and at any recessed
expressly
12in room 13.
or adjourned date, to testify and give evidence as a witness in this action on the part of the
13 consent that any adoption proceeding may be heard at any time without notice to me.
14
Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to
14.
I acknowledge that I have received a copy of this document.
the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a
15result of your failure to comply. ________________ , 20 _______.
DATED this _______ day of
Witness, Honorable
, one of the Justices
16 Executed at ___________________________________ at _______ o’clock _____. m. of the
Court in
(location)
County,
day of
, 20
17
___________________________________
18
(Attorney must sign above and type name below)
Relinquishing Parent
19
20
Attorney(s) for
21
22
Office and P.O. Address
23
Telephone No.:
Facsimile No.:
24
E-Mail Address:
Mobile Tel. No.:
Affidavit of Waiver of All Parental Rights, Relinquishment of Child, & Consent to Adoption
Page 3
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COURT
COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
......... ..
:
:
Index No.
Calendar No.
1 SUBSCRIBED AND SWORN TO before me this __ day of: ___________ , 20__ by [NAME OF
JUDICIAL SUBPOENA
Plaintiff(s)
RELINQUISHING PARENT].
-against:
2
__________________________________________
:
Notary's Signature
3
Notary Public for the State of _________________
:
4
Printed
Defendant(s) name of notary _______________________
:
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Title . . .rank: . ______________________________
. . . . or . . . . .
5
Residing at _______________________________
My Commission Expires: ____________________
6
THE PEOPLE OF THE STATE OF NEW YORK
7
TO
8 (Seal)
9
GREETINGS:
10
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
,
the Honorable
at the
Court
11
located at
County of
, on the
day of
, 20
, at
o'clock in the
noon, and at any recessed
12in room
or adjourned date, to testify and give evidence as a witness in this action on the part of the
13
14
Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to
the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a
15result of your failure to comply.
Witness, Honorable
Court in
County,
, one of the Justices of the
16
day of
, 20
17
18
(Attorney must sign above and type name below)
19
20
Attorney(s) for
21
22
Office and P.O. Address
23
Telephone No.:
Facsimile No.:
24
E-Mail Address:
Mobile Tel. No.:
Affidavit of Waiver of All Parental Rights, Relinquishment of Child, & Consent to Adoption
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