CHECKLIST Petition To Voluntarily Relinquish Parental Rights – To Individual 23 Pa. C.S.A. § 2502 Rule 15.3 (Documents to be attached to the Petition in the order they appear): _____ Preliminary Decree – Rule 15.1A(4) _____ Final Decree _____ Important Notice – Rule 15.1A(4) _____ Petition to Voluntarily Relinquish Parental Rights ___ ___ ___ ___ Attorney Caption Signed by Attorney or Petitioner Verified by Petitioner Petitioner is Relinquishing Birth Parent _____ Date when Report of Intention to Adopt was filed – Rule 15.3(a)(1) _____ Date when child was placed with Adult(s) – Rule 15.3(a)(2) _____ Joinder of a parent who is not a petitioner or his or her waiver of all interest in the child if either is obtainable, if not explain why – Rule 15.3(b) _____ Consent of a parent or guardian of a petitioner who has not reached 18 years old – Rule 15.3(b) _____ Consent of adult(s) to accept custody of the child – Rule 15.3(b)(1) _____ Original Long Form Birth Certificate – Rule 15.2(b)(2) _____ Out-of-County Decrees Certified _____ Foreign Documents Translated _____ Notice(s) Pursuant to 23 Pa.C.S.A. §2513(b) ____ at least ten (10) days notice by personal service, OR ____ Registered Mail, OR ____ By such means as the Court may require (See, Pa.R.C.P. 430) ____ Proof of Notice(s) – to be filed at or before the hearing NOTE: PETITIONER'S PRESENCE IS REQUIRED AT HEARING American LegalNet, Inc. www.USCourtForms.com