IN THE COURT OF COMMON PLEAS OF CHESTER COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION IN RE: {use initials only} Case Number: ___________________________ PETITION FOR ALTERNATIVE RELINQUISHMENT OF PUTATIVE FATHER FINAL DECREE AND NOW, this _____ day of ______________________, 20__, after review of the record and hearing following due notice, the court, being satisfied as to the truth of the facts set forth in the petition and that the petition should be granted, finds that [PUTATIVE FATHER] received proper and due notice in accordance with 23 Pa.C.S. §2503, has failed to file an acknowledgment of paternity pursuant to 23 Pa.C.S. §5103(b). The putative father has also failed to make objection at this hearing either in person or in writing. Accordingly, THE PARENTAL RIGHTS OF SAID PUTATIVE FATHER ARE HEREBY TERMINATED pursuant to 23 Pa.C.S. §2504(c) and the adoption of Adoptee may continue without further consent of, or notice to said putative father. BY THE COURT: __________________________________________ J. American LegalNet, Inc. www.FormsWorkFlow.com