WPCqI  
      %     ʹyy+ƣ(	pkIK WXOZTF9EI
Ri 2BH`/hԞ?kO{btk
H$ڴMlwBd/h%4-UoRzݥe8¦+.c`.i.ZmGx&JDyFJmj?WcLSi* [)j"_EbN"/	ypA02	OJO	:?0J$fV5]U_d29j>*1.CV ;}a6m!#6\9qP^fp<a
hn|zHNDˠn{SV3TYiqZgʏN\gܧj'P˷?R~[EPiK+īimL>ר#zjzp/yJo:m p           #   !      U   N   A	  	%      	  0   :   	  0      	  0      
  0        0        0        0      u  0      Z  0      <  0        0        0        0        0        0      m  0      C  0        0        0        0      }  0      ^  0      <  0        0        0        0        0      e  0      1   0   0      0   <   *!  0      f!  0   >   $"  0   v   b"  0   `   "  0   `   8#  0   `   #  0   `   #  0   `   X$  0   8   $  0      $  0   2   %  0      %  0   :   &  0   Y   *'  0   _   '  0   
  '  0   j  (  0     V*  	B   *   +  	D   /   ,  	D   +   3,  0     ^,  	D   /   -  0      .  0   6   .  0     /  0   :   0  0   ^   W0  0   <   0   U   6   0   U   >   '1   U   *   e1  	1      1   U   @   2   U)   ,   V2   	      2   	      2   	      2  N      2  ^      2  w   @   2  4       3        3        #3  	m      %3   U   N   <3  0   U   3  0      3  0      4  0      5  0      6  0      q7  0      N8  0      (9  0      9  0   C   :  0      ;  0      ;  0      <  0      =  0      `>  0      +?  0      ?  0      @  0   @   xA  0      A  0      B  0      ]C  0      +D  0      D  0      E  0      F  0      EG  	1   e   H            H  	1   u   gH  	7   2   H  0   c   I   H P   L a s e r J e t   4 0 0 0   S e r i e s   P C L 6                                                       V,,,, V0                                                                                                                                                                 ( 9  	   Z  6 T i m e s   N e w   R o m a n   R e g u l a r           X    (                  $          USUS. ,      2   J   +       M   0 _ l e v e l 1            X 2  (   `	   h   p    x  2 2      3
   
       . .          5  +    `	   h   p    x  5         2   G   +       M   0 _ l e v e l 2             /  % `	 `	   h   p    x  / 2     3
   
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   h   p    x  , 2     3
   
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   
       . .          5  +    `	   h   p    x  5         2   >   +       M   0 _ l e v e l 5             &   h h   p    x  & 2     3
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       5  +    `	   h   p    x  5         2   2          M   0 _ l e v n l 9                    x   2     3
   
       5  +    `	   h   p    x  5         0                   . N o r m a l         <                   : D e f i n i t i o n   T         <   A           A   : D e f i n i t i o n   L        , 5  +    `	   h   p    x  5       5  +    `	   h   p    x  5     8                  6 D e f i n i t i o n         (   '           '   & H 1                             X      XX     (                 & H 2                    X      XX     (                 & H 3                    X      XX     (                 & H 4         X      XX     X      XX     (                 & H 5                    X      XX     (                 & H 6                    X      XX     2                 0 A d d r e s s         8   M           M   6 B l o c k q u o t e        ,    , 5  +    `	   h   p    x  5             5  +    `	   h   p    x  5     ,                  * C I T E         ,       d       l    * C O D E                K ?          < 6X  9   ` (  C o u r i e r   N e w         K     X      XX S @           \	  	   `  & T i m e s   N e w   R o m a n         S     4                  2 E m p h a s i s         6                  4 H y p e r l i n k                    <                  : F o l l o w e d H y p e                   4       g       o    2 K e y b o a r d                K ?          < 6X  9   ` (  C o u r i e r   N e w         K     X      XX S @           \	  	   `  & T i m e s   N e w   R o m a n         S     <                 : P r e f o r m a t t e d     /  %    
  , K k     %#/            K ?          < 6X  9   ` (  C o u r i e r   N e w         K     X      XX S @           \	  	   `  & T i m e s   N e w   R o m a n         S /  %    
  , K k     %#/     <                 : z  B o t t o m   o f       7 5   (                   X                 7                ? A          % 2  A   `   A r i a l         ? 7 6   (                   X                 7          X      XX S @           \	  	   `  & T i m e s   N e w   R o m a n         S   &              d          d   4 )     1                        d x    d  '                              d x    d    <                 : z  T o p   o f   F o r     7 8   (                   X                 7                ? A          % 2  A   `   A r i a l         ? 7 6   (                   X                 7          X      XX S @           \	  	   `  & T i m e s   N e w   R o m a n         S  4 )     2                        d x    d    0       K       S    . S a m p l e     K ?          < 6X  9   ` (  C o u r i e r   N e w         K S @           \	  	   `  & T i m e s   N e w   R o m a n         S     0                  . S t r o n g         8       d       l    6 T y p e w r i t e r                K ?          < 6X  9   ` (  C o u r i e r   N e w         K     X      XX S @           \	  	   `  & T i m e s   N e w   R o m a n         S     4                  2 V a r i a b l e         :                  8 H T M L   M a r k u p     B
   
                2       
            0 C o m m e n t     B
   
 < 6X  9   ` (  C o u r i e r   N e w          \	  	   `  & T i m e s   N e w   R o m a n         % 2  A   `   A r i a l                          (5h        C E K Q W ] c i o A u t o L i s t 1     1 .   1 .   1 .   1 .   1 .   1 .   1 .   1 .                     ( 9  	   Z  ( T i m e s   N e w   R o m a n           , c  A   Z   A r i a l            S D U _ 5    S D U _ 6    S D U _ 7    \n2     
      [ !  [ "  U #   $  a %  U &  D '  b (  U )   va2    :i +003| x   )                U  ( @  	   Z   6 T i m e s   N e w   R o m a n   R e g u l a r             *       +           ( _ 2 6     2      3
   
       . .        *   G   +       M   ( _ 2 5             /  % `	 `	   h   p    x  / 2     3
   
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   h   p    x  , 2     3
   
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   
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   
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   
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   
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   
 Ԁ    *   G          M   ( _ 1 6             /  % `	 `	   h   p    x  / 2     3
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   h   p    x  , 2     3
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   
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   
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   
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   
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     (   G          M   & _ 7             /  % `	 `	   h   p    x  / 2     3
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       5  +    `	   h   p    x  5         (   D          M   & _ 6             ,  " 
   h   p    x  , 2     3
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       5  +    `	   h   p    x  5         (   A          M   & _ 5            `	 )   	  h   p    x  ) 2     3
   
       5  +    `	   h   p    x  5         (   >          M   & _ 4             &   h h   p    x  & 2     3
   
       5  +    `	   h   p    x  5         (   ;          M   & _ 3             #      p    x  # 2     3
   
       5  +    `	   h   p    x  5         (   8          M   & _ 2            h       p    x    2     3
   
       5  +    `	   h   p    x  5         (   5          M   & _ 1                p p    x   2     3
   
       5  +    `	   h   p    x  5         &   2          M   $ _                    x   2     3
   
       5  +    `	   h   p    x  5      Y Z [ \ ] ^ _ `          3 5 ; A G M S Y _ 1     1 .   1 .   1 .   1 .   1 .   1 .   1 .   1 .                    3#   3 7 = C I Q Y a g       1 .   a .   i .   ( 1 )   ( a )   ( i )   1 )   a )            m    i )                                           (       ;           3$       2  #      0
   
 .3
   
 0     
   !    USUS. ,      _            X    X  D  X X  X X            = (#  D    XD X  O    D  K.S.A.592124   	 X          **3 (# RelinquishmenttoAgency(     D!D!C (# ( ) # O  Xi X O    #  O  P	  XO Xi (7/1/05)# O  Xi X	 O Ph  # # D  X X XO XiԵ   #  O  Xi X XD X  O    XO Xi ) # D    O   # # D  X X D   # Ԉ   	    @    

  RELINQUISHMENTOFMINORCHILDTOAGENCY@    		  NOTICETOPARENTORPERSONINLOCOPARENTIS:   	 @        Thisisanimportantlegaldocumentandbysigningityouarepermanently   	 	   givingupallcustodyandotherparentalrightstothechildnamedherein.Youaretoreceiveacopyofthisdocument.   	 

        I,򀀀 D  & % XD X (name)# D  X X %D &+  # Ԁ,(mother,father,personinlocoparentis)of򀀀   	 `
   Ѐ,aminorchild,state:   	 F   1.     Thechildwasbornon D  & % XD X Ԁ(dateofbirth)# D  X X %D &X  # at򀀀 D  & % XD X (placeofbirth)# D  X X %D &  # Ԁat򀀀򀀀.m.   	 j   2.     Iresideat򀀀,Countyof򀀀andStateof򀀀.   	 6   3.     Iamoftheageof򀀀yearsandwasbornon򀀀.   	                          L 	B                  5h        (            3m                 L   o  3                       o  3   2  5h      4
   
 .3
   
 0          [NeitherthechildnorIamamemberofanIndiantriberecognizedbyfederallawnor   	 v   anAlaskanNativerecognizedbyfederallaw.][Iamamemberofthe򀀀   	 \   Ѐtribe,򀀀 D  & % XD X (address)# D  X X %D &f	  # ].[Thechildisamemberofthe򀀀   	 B   Ѐtribe,򀀀 D  & % XD X (address)# D  X X %D &)
  # Ԁ.] o  3  	   ݌    ( (#(#  Ќ	       o  3                       o  3
   2  5h      5
   
 .3
   
 0          Idoherebyrelinquishthechildto򀀀 D  & % XD X (nameofagency)# D  X X %D &  # Ԁ,whichIunderstandwillhave   	 L   fullpowerandalltherightsofabirthparentorlegalguardianoverthechild,includingthepowertoplacethechildforadoptionandgiveconsentthereto. o  3
  
   ݌    (#(#  Ќ	       o  3                       o  3   2  5h      6
   
 .3
   
 0          IwishtoandunderstandthatbysigningthisrelinquishmentIdopermanentlygive   	    upallcustodyandotherparentalrightsIhavetosuchchild,includingtherighttoreceivenoticeofanysubsequentadoptionproceedingsinvolvingthechild. o  3     ݌    (#(#  Ќ	       o  3                       o  3   2  5h      7
   
 .3
   
 0          IhavereadandunderstandtheaboveandIamsigningitasmyfreeandvoluntary   	 | $"   act. o  3     ݌    (#(#  Ќ	     Dated򀀀,at򀀀򀀀.m.0           D  & % XD X Ԁ(signatureofparent)# D  X X %D &@  #     .# % (#(#           `	               h                    `	               h               p [Mustbeacknowledgedbeforeeitherajudgeoranotarypublic.Choosetheappropriate   	 %#(   acknowledgmentfromthetwooptionsbelow.]   	 &m$)   @      ACKNOWLEDGMENTBEFOREJUDGEOFDISTRICTCOURT D    XD X STATEOF򀀀)   	 \*(-            `	           )ss:COUNTYOF򀀀)   	 +)/   # D  X X D   #      I,򀀀,Judgeof D  & % XD X (nameandlocationofcourt)# D  X X %D &  # certifythat򀀀   	 -*+1   Ѐ,knowntometobethesamepersonwhosenameissubscribedtotheforegoing   	 h.,2   relinquishment,appearedbeforemethisdayinpersonand% E    % E      acknowledgedthat(she)(he)signedsuchrelinquishmentas(her)(his)freeandvoluntaryact,forthespecifiedpurpose.   	 40-4              Ihavefullyexplainedthatbysigningsuchrelinquishment(she)(he)ispermanently   	 >    givingupallparentalrightstosuchchildand(she)(he)hasstatedthatsuchis(her)(his)intentionanddesire.            Dated  __________  ,at    ______    ! ! ___! ! .m.          򀀀 D  & % XD X (signatureofjudge# D  X X %D &q  # )   	 ~            `	               h                          `	               h         ACKNOWLEDGMENTBEFORENOTARIALOFFICER      D    XD X STATEOF򀀀)   	 T
            `	           )ss:      COUNTYOF򀀀)# D  X X D   #    	 |
              I,anotarialofficerinandforthecountyandstateaforesaid,certify% F    % F   Z   that򀀀   	 z"   Ѐ,knowntometobethesamepersonwhosenameissubscribedtothe   	 `   foregoingrelinquishment,appearedbeforemeinpersonandacknowledgedthatthestatementsmadeintheforegoingrelinquishmentaretrue.Dated򀀀at򀀀򀀀.m.0      D  & % XD X (signatureofnotarialofficer)# D  X X %D &  #  D    XD X Ԁ# D  X X D a  #  @     @     @     @     @     @         (#(#        (SEAL,ifany)              h           򀀀 D  & % XD X title(andrank)# D  X X %D &  # Ԁ D    XD X          	 l            `	               h      # D  X X D   # Ԁ   	 R                       S W\             0     0    `	(#(# 0    `	(#`	(# 0    (#(# 0    h(#(# 0    h(#h(# 0    (#(#          ݌    (#(#  Ќ	     [MyAppointmentExpires:_________]            @      ACCEPTANCEOFCHILDBYAGENCY                 I,򀀀,theundersigned,onbehalfof D  & % XD X (nameofagency)# D  X X %D &!  # Ԁ,do   	    herebyacceptcustodyof______________________,% G    % G   c"   theaboverelinquishedminorchild.      Date򀀀         h               p  D  & % XD X (signatureandtitle)# D  X X %D &#  #    	  m"            `	               h               p                     `	               h               p      @    BB  CERTIFICATEOFATTORNEYFORRELINQUISHINGMINORPARENT     Iamalicensedattorneyrepresenting򀀀,whoisaminor.I   	 C%"'   havefullyexplainedthatbysigningthisrelinquishment򀀀is   	 )&#(   permanentlygivingupallparentalrightstothechildand(she)(he)hasstatedthatsuchis(her)(his)intentionanddesire.Iwaspresentattheexecutionofthisrelinquishment.Date򀀀     0    h 0    h(#h(# 򀀀 D  & % XD X (signatureofattorney)# D  X X %D &'  #     )i', (#(#       	   	 *O(-   $     eX $ '    X ' @    {{&   C  Xo  X XD X  C   	   XC Xo Authority   	 K    K.S.A.592124;592115;592116;and592117.     @    $  NotesonUse   	 u        Relinquishmentofachildtoanadoptionagencymayonlybemadeiftheagencyacceptstherelinquishmentinwriting.K.S.A.592124(a).Oncetherelinquishmentismadeandaccepted,theagencystands   	 
p   inlocoparentistothechildandhastothepowertoplacethechildforadoptionandgrantconsenttotheadoption.   	 :	        K.S.A.592124(c)providesthatallrelinquishmentsmustbeinwritingandacknowledgedbeforeajudgeofacourtofrecordoranofficerauthorizedbylawtotakeacknowledgments.Ifajudgeacknowledgestherelinquishment,thejudgehasadutytoadvisetherelinquishingpersonoftheconsequencesoftherelinquishment.Iftherelinquishmentisexecutedandacknowledgedoutsidethestate,itisvalidaslongasitwasdoneinaccordwiththelawoftheplacewhereexecutedorthelawofKansas.K.S.A.592117.     K.S.A.592124(a)providesthataparentor personinlocoparentismayrelinquishachildtoanagency,   	 %   butdoesnotexplainwhenanonparentwouldhavesufficientauthorityasasubstituteparenttorelinquishachild.TheKansasGuardianshipstatuteprovidesthataguardiandoesnothaveauthoritytoconsenttotheadoptionofaward,unlessapprovedbythecourt.K.S.A.593075(e)(3).Iftherelinquishmentisbyapersoninlocoparentis   	    therelinquishmentshouldhaveattacheddocumentssupportingtheperson'sauthoritytoexecutetherelinquishment,suchasacourtorderauthorizingsuchrelinquishmentbyaguardian.Althoughtherelinquishmentstatutedoesnotspecificallyrequiresuchdocuments,oneoftheconsentstatutes,K.S.A.592129(e),doesrequiresuchdocuments.     Inorderforarelinquishmentsignedbyaminorparenttobevalid,theminormusthaveadviceoflegalcounselastotheconsequencesoftherelinquishmentandthelegalcounselmustbepresentattheexecutionoftherelinquishment.K.S.A.592115.Therelinquishmentformshouldincludeacertificatefortheminorsattorneytosignverifyingthattheseconditionshavebeenmet.Thecostofcounselmustbeprovidedbytheadoptiveparentsorbytheagency,unlesstheminorisrepresentedbyhisorherowncounsel.     Theacceptancebytheagencyoftherelinquishmentterminatesparentalrights,includingtherighttonoticeofasubsequentadoptionandtherighttoinheritfromthechild.Whenaparentsignsarelinquishment,believingthattheotherparentwillalsorelinquish,thusfreeingthechildforadoption,andtheotherparentdoesnotrelinquish,parentalrightsoftherelinquishingparentarenotterminated.K.S.A.592124(d).     Arelinquishmentdoesnotterminatetherightofthechildtoinheritfromtherelinquishingparent.K.S.A.592124(e).     Arelinquishmentsignedbyamotherwithin12hoursafterthebirthofthechildisvoidable,priortothefinaldecreeofadoption.K.S.A.592116.Thustoensureavalidadoption,thepartysecuringtherelinquishmentshouldtakecaretowaituntilaftertheminimum12hourperiodhasexpired." " #          	 	 C   IndianChildWelfareAct(_        ICWA_        ).The_        ICWA_        appliestoadoptionplacementsofIndianchildren(25   	 "&   U.S.C.1903(1)(iv)),requiringnoticetothetribeandadoptionplacementpreferences(25U.S.C.1915(a)).Indianchildrenaredefinedasunmarriedpersonsundertheageof18whoareeither(a)membersofanIndiantribeor(b)eligibleformembershipandthebiologicalchildrenofamemberofanIndiantribe.25U.S.C.1903(4).Paragraph4oftherevocationformisincludedtoprovideinformationaboutwhetherthechildmeetsthedefinitionofIndianchildunderthe_        ICWA_        .    h    	 v&"+        IfthechildisanIndianchild,thecourtmaynonethelessdeterminethatthe_        ICWA_        ԀdoesnotapplyifthechildhasneverbeenamemberofanIndianhomeorculture,pursuanttotheholdingin_        In_        ԀreAdoptionofL.,231   	 
(#-   Kan.199,643P.2d168(1982).Ifsuchfactsexist,aparagraphmaybeaddedtotheformestablishingthosefacts.Also,evenifthe_        ICWA_        Ԁapplies,thecourtmaydeterminethatgoodcauseexistsnottofollowtheotherwiserequiredadoptionplacementpreferences.InreAdoptionof_        B.G.J._        ,111P.3d651(_        Kan_        .Ct.App.2005).# C   	 	   }5  #    	 h*&0   # C  Xo  X	 C  (  #  C   	   XC Xo # % %  & &      @    YY&  Comments   	 ,a(3            `	      b 
k Y Z [ \ ] ^ _ `   (         0                                    (B                 b      Therelinquishmentofachildtoanagencyforadoptionmustbeacceptedinwritingbythatagencyinordertobeeffective.InreBabyBoyN.,19Kan.App.2d574,874P.2d680(1994)(construingK.S.A.592124(a)).   	 &/*6        Voluntaryrelinquishmentofparentalrightsandacceptancebyanadoptionagencyterminatesparentalrightsandobligations,includingtheobligationtopaychildsupport.Secretaryof_        SRS_        Ԁv.Clear,248Kan.109,   	 /    804P.2d961(1991).However,adecreeofadoptiondoesnotrelieveaparentofhisorherobligationtopaythechildsupportdueandowingatthetimeoftheadoption.Childsupport_        arrearages_        Ԁwhichhavebeenreducedtojudgmentarenotextinguishedorcanceledbyterminationofparentalrights._        Michels_        Ԁv._        Weingartner_        254Kan.   	 (   44,49,864P.2d1189(1993).     Ithasbeenheldthatstatutoryrelinquishmentauthorizesdivestitureofparents'rights,andmustbestrictlyconstruedinfavorofmaintainingthoserights.Wilsonv.KansasChildren'sHome,159Kan.325,32930,154P.2d   	 	   137(1944)(construingG.S.1935,38113,thepredecessorofK.S.A.592124).       @   	 	 C      	 
P   # C   	 	 @  WB  # # C  Xo  X	 C  ;  # 
