Download Free Print-Only PDF OR Purchase Interactive PDF Version of this Form
Consent To Termination Of Parental Rights Affidavit Form. This is a Wisconsin form and can be use in Circuit Court Statewide.
Loading PDF...
Tags: Consent To Termination Of Parental Rights Affidavit, JC-1636, Wisconsin Statewide, Circuit Court
FORM SUMMARY
Name of Form:
Consent to Termination of Parental Rights (Affidavit)
Form Number:
JC-1636
Statutory Reference:
§§48.41(2)(c) and 48.41(2)(d), Wisconsin Statutes
Benchbook Reference:
JV 13
Purpose of Form:
Affidavit by a parent consenting to the termination of their parental
rights to a child.
Who Completes It:
Party seeking the termination will usually make the arrangements to
have this affidavit completed.
Distribution of Form:
Original filed with the court.
Accompanying Forms:
May accompany the Petition for termination of parental rights
(voluntary) or may be received subsequent to the filing of the
petition.
New Form/Modification:
Modification, last update 07/05.
Modifications:
Added Indian Child Welfare Act (ICWA) language and references.
Comments:
None
About this form:
This form is the product of the Wisconsin Records Management
Committee, a committee of the Director of State Court's Office
and a mandate of the Wisconsin Judicial Conference.
If you have additional information that does not change the
meaning of the form, attach it on a separate page. The form
itself shall not be altered.
Date: 04/24/2008
Page 1
American LegalNet, Inc.
www.FormsWorkflow.com
COUNTY
STATE OF WISCONSIN, CIRCUIT COURT,
IN THE INTEREST OF
For Official Use
Consent to Termination
of Parental Rights (Affidavit)
a person under the age of 18.
Case No.
Date of Birth
UNDER OATH, I STATE:
1. My name is
My address is
My date of birth is
2. My child is not a member of or eligible for membership in an Indian tribe.
3. For stepparent adoptions:
father
of this child
mother
• I am the
was not
born during a marriage with the other parent.
was
• The child
For non-marital, non-adjudicated alleged fathers:
, mother of this child.
• I have never been married to
• I have never been adjudicated (formally determined by a court) to be the father of this child.
• I am aware that I am alleged to be the father of this child.
• I am not admitting or denying that I am the father of this child.
4. I know that a petition to terminate my parental rights has been or will be filed.
5. I have been informed and understand that a court order terminating parental rights will permanently end ALL
legal rights and duties that exist between myself and this child, such as:
• Duty to support
• Right to custody and visitation
• Right to inherit
6. I wish to give up any parental rights that I may have to this child and consent to the court entering an order
terminating my parental rights.
7. I give up the right to know of any future hearing or proceedings in this matter.
8. I am making this decision on my own free will. No promises or threats have been made to get me to sign this
document.
Subscribed and sworn to before me
on
Signature
Notary Public, State of Wisconsin
Name Printed or Typed
My commission expires:
Date
FOR STEP PARENT ADOPTIONS, YOU MUST HAVE
TWO WITNESSES SIGN BELOW IN ADDITION TO
COMPLETING THE NOTARY SECTION ABOVE.
Signature of Witness
Signature of Witness
JC-1636, 04/08 Consent to Termination of Parental Rights (Affidavit)
§§48.41(2)(c) and 48.41(2)(d), Wisconsin Statutes
This form shall not be modified. It may be supplemented with additional material.
American LegalNet, Inc.
www.FormsWorkflow.com
