FORM SUMMARY Name of Form: Consent to Use Mother's Name for Publication Form Number: JC-1634 Statutory Reference: §§48.42, Wisconsin Statutes Benchbook Reference: JV 13 Purpose of Form: Authorization by mother to use her name in the notice when publication is required for a termination of parental rights petition. Who Completes It: Petitioner bringing the action to terminate the rights of a natural father. Distribution of Form: Original to court file; copy to newspaper for publication. Accompanying Forms: Generally none New Form/Modification: Modification; last update 6/96. Modifications: Added a file/date stamp area to upper left corner. Added a statement on the bottom indicating that the form shall not be modified. 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. I f 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: 11/19/99 Page 1 American LegalNet, Inc. www.FormsWorkflow.com For Official Use STATE OF WISCONSIN, CIRCUIT COURT, COUNTY Consent to Use Mother’s Name for Publication IN THE INTEREST OF a person under the age of 18. Case No. Date of Birth If the natural father cannot be personally served, the law requires service by publication. Publication will be in a newspaper likely to give notice to the father. If publication is necessary, I: consent to the use of my name. do not consent to the use of my name. Signature of Mother Name Printed or Typed Date JC-1634, 11/99 Consent to Use Mother’s Name for Publication (Termination of Parental Rights) §§48.42, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. American LegalNet, Inc. www.FormsWorkflow.com