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I,__________,(mother,father,legalguardian)of_________________,aminor o  child,% M %Mstate:  2.  ThechildwasbornonL&˝%XLXgԀ(dateofbirth)#LXgX%L&˝:#at򀀀L&˝%XLXg(placeofbirth)#LXgX%L&˝#Ԁat________.m. ! 3.  Iresideat________________,countyof__________andstateof__________.  [Mysocialsecuritynumberis򀀀.] { 4.  Iamoftheageof򀀀yearsandwasbornon򀀀. G  5.  Idoherebyconsentandagreetotheadoptionofthechild[by______________] k [andIdonotrequiredisclosureofthenameorotheridentificationoftheadoptingparentorparents].  % N %N} 6.  IwishtoandunderstandthatbysigningthisconsentIdopermanentlygiveupall  custodyandotherparentalrightsIhavetothechild.  7.  [Iamofsoundmindandundernounduerestraintorduress.]Ihavereadand ]  understandtheaboveandIamsigningitasmyfreeandvoluntaryact.8.  [Iwasmarriedto򀀀atthetimeofthechilds g!# (conception)(birth)andheisthefatherofthechild.Hispresentaddressis򀀀 M"$ Ѐ.] 3# % 9.  [Iwasnotmarriedatthetimethechildwasconceivedorborn.Thefatherofthe $"' childis򀀀,whosepresentaddressis򀀀.] %#( [Therearenootherpossibleputativefathers.][򀀀was &s$) determinedtobethechildsfatherin򀀀DistrictCourt,casenumber 'Y%* 򀀀.] (?&+ 10.  C[NeitherthechildnorIamamemberofanIndiantriberecognizedbyfederallaw c* (- noranAlaskanNativerecognizedbyfederallaw.][Iamamemberofthe򀀀 I+(. Ѐtribe,򀀀L&˝%XLXg(address)#LXgX%L&˝#].[Thechildisamemberofthe򀀀 /,)/ tribe,򀀀L&˝%XLXg(address)#LXgX%L&˝q#Ԁ.] -*0 CFBBFE11.ED  DIherebyfreelyandvoluntarilyentermyappearanceinanyproceedinginstituted .,2 inanycourtofcompetentjurisdictionfortheadoptionofthechildandwaivenoticeofallproceedingsoftheadoption. 0U.4 Ї    Dated `    ,at h   .m.   !  S)~!  0  0` (#(#0 ` (#` (#0 (# (#0h(#(#0h(#h(#  L&˝%XLX(signatureofparentorlegalguardian#LXX%L&˝#)!@݌)(#(# Ќ  [Mustbeacknowledgedeitherbeforeajudgeoranotarypublic.Choosetheappropriate  acknowledgmentfromthetwooptionsbelow.]   @ACKNOWLEDGMENTBEFOREJUDGEOFDISTRICTCOURTLXLXSTATEOF `    ) q      `    )ss:COUNTYOF0 ` 0 ` (#` (#0 (# (#)#LXXL# (#(#     I,򀀀,JudgeofL&˝%XLX(nameandlocationofcourt)#LXX%L&˝#Ԁ,certifythat ?    `    ,knowntometobethesamepersonwhosenameissubscribed }% totheforegoingconsent,appearedbeforemethisdayinpersonand% C %CRacknowledgedthat(she)(he)signedsuchconsentas(her)(his)freeandvoluntaryact,forthespecifiedpurpose.    Ihavefullyexplainedthatbysigningsuchrelinquishment(she)(he)ispermanentlygivingupallparentalrightstosuchchildand(she)(he)hasstatedthatsuchis(her)(his)intentionanddesire.  Dated򀀀,at򀀀򀀀.m.     p L&˝%XLX򀀀(signatureofjudge) #LXX%L&˝R# U    `        `     h   !  S@E!b  @g g ACKNOWLEDGMENTBEFORENOTARIALOFFICER!b݌̌  !  !   LXLXSTATEOF `    )!*݌ d  Ќ     `    )ss: COUNTYOF `    )#LXXLW# !    I,anotarialofficerinandforthecountyandstateaforesaid,certify% D %Dthat !2# __________________,knowntometobethesamepersonwhosenameissubscribedtotheforegoingconsent,appearedbeforemeinpersonandacknowledgedthatthestatementsmadeinsaidconsentaretrue.Dated򀀀at򀀀.m.0  0(#(#L&˝%XLX(signatureofNotarialOfficer)#LXX%L&˝f#Ԁ&#((#(#     `     h      (L&˝%XLXSEAL,ifany#LXX%L&˝a #) `     h     L&˝%XLX򀀀title(andrank) #LXX%L&˝!#LXLX (b&+    `     h #LXXL!#  !  S,M*R,)!0"  0  0` (#(#0 ` (#` (#0 (# (#0h(#(#0h(#h(#0(#(#!0"`"݌ (#(# Ќ  L&˝%XLX[MyAppointmentExpires:_________]#LXX%L&˝>## -3+0   )0-3 @, , CertificateofAttorneyforConsentingMinorParent!  Sw$!&$     Iamalicensedattorneyrepresenting򀀀,whoisaminor.I ] havefullyexplainedthatbysigningthisconsent򀀀ispermanently C givingupallparentalrightstothechildand(she)(he)hasstatedthatsuchis(her)(his)intentionanddesire.Iwaspresentattheexecutionofthisrelinquishment.!&$V$݌̌  Dated򀀀 h 0  0(#(#򀀀(L&˝%XLXsignatureofattorney#LXX%L&˝&#)  @  @  @  @  @  @      (#(# XXXLX@{{& c XX Authority   5  K.S.A.592114;592115;592116;592117;592129@  $ NotesonUse  _    WhoseConsentisRequired .K.S.A.592129setsforththelistofrequiredconsents.Forindependent M adoptions,thefollowingpersonsmustconsent:(1)bothlivingparentsoroneparent,iftheothersconsentisfoundunnecessaryunderK.S.A.592136,or(2)ifbothparentsaredeadortheirconsentsarefoundunnecessaryunderK.S.A.592136,thelegalguardian(withapprovalbythecourtintheguardianshipaction),or(3)thejudgewhoterminatedparentalrightsinacodeforthecareofchildrenproceeding.Inaddition,consentmustbegivenby(1)thejudgehavingjurisdictionoverthechildinacodeforthecareofchildrenproceedingifparentalrightshavenotbeenterminatedand(2)thechild,ifover14yearsofageandofsoundintellect.Iftheconsentisbyalegalguardian,theconsentshallhaveattacheddocumentssupportingtheguardian'sappointmentandtheauthorityoftheguardiantoexecutetheconsent.   Foragencyadoptions,consentmustbegivenby(1)theauthorizedrepresentativeoftheagencytowhomthechildhasbeenrelinquishedand(2)thechild,ifovertheageof14andofsoundintellect.  Forstepparentadoptions,theconsentofbothparentsisrequired,ortheconsentofoneiftheothersconsentisfoundunnecessaryunderK.S.A.592136.  Formandacknowledgment. Consentsmustbeinwritingandacknowledgedbefore c   cԀajudgeofacourt : ofrecordoranofficerauthorizedbylawtotakeacknowledgments.Ifajudgeacknowledgestherelinquishment,thejudgehasadutytoadvisetherelinquishingpersonoftheconsequencesoftherelinquishment.K.S.A.592114(a).  TherearespecialrulestocoverconsentsexecutedoutsideofKansasorbymilitarymembers.Iftheconsentisexecutedandacknowledgedoutsidethestate,itisvalidaslongasitwasdoneinaccordwiththelawoftheplacewhereexecutedorthelawofKansas.However,whenaconsentorrelinquishmentissignedinaforeigncountry,theexecutionmustbeacknowledgedinaccordancewiththelawandprocedureoftheforeigncountry.ForconsentingpersonswhoareintheUSmilitary,theconsentmaybeacknowledgedbeforeacommissionedofficerandthesignatureoftheofficermustbeproperlyverifiedoracknowledgedbyanotarypublicoranotherauthorizedmilitaryprocedure.K.S.A.592117.# c   c^.# c   c y#!!(   # c   c|2#Itisnotnecessarytoplaceacasecaptionatthebeginningoftheconsentform;sometimestheconsent C$!) mustbeobtainedbeforethepropercaptioncanbeformulated.Itisnecessary,however,tofiletherequiredconsentswiththeadoptionpetition.K.S.A.592128(b).Itisalsonotrequiredthattheconsentauthorizeaspecifiedpersontoadopt,althoughthatisoftendone. c   c &I$,   # c   cr4#Timeofconsent .Consentsareonlyvalidifexecutednomorethansixmonthspriortothefilingofthe k'%- adoptionpetition.K.S.A.592114(b).Inaddition,theconsentofthemothergivenwithin12hoursafterthebirthofthechildisvoidable,priortothefinaldecreeofadoption.K.S.A.592116.  Consentofminorparent.  c   cInorderforconsentsignedbyaminorparenttobevalid,theminormusthave )t'0 adviceoflegalcounselastotheconsequencesoftherelinquishmentandthelegalcounselmustbepresentattheexecutionoftherelinquishment.K.S.A.592115.Theconsentformshouldincludeacertificatefortheminorsattorneytosignverifyingthattheseconditionshavebeenmet.Thecostofcounselmustbeprovidedbytheadoptiveparentsorbytheagency,unlesstheminorisrepresentedbyhisorherowncounsel.# c   cJ6# c   cԀ# c   c8#  ,*4   Revocation. Consentsarefinalwhenexecuted,unlesstheconsentingparty,priortotheentryofthefinal -i+5 decreeofadoption,provesbyclearandconvincingevidencethattheconsentwasnotfreelyandvoluntarilygiven.592114(a).   c   c 0.9 O_R O9 O  HHI# c   c*:#  Identityoffather. Paragraph8or9shouldbeinsertedinconsentformstobesignedbythechilds X mother,inordertoidentifythechildsfather.  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).Paragraph10oftheconsentformisincludedtoprovideinformationaboutwhetherthechildmeetsthedefinitionofIndianchildunderthe_ICWA_. h     IfthechildisanIndianchild,thecourtmaynonethelessdeterminethatthe_ICWA_ԀdoesnotapplyifthechildhasneverbeenamemberofanIndianhomeorculture,pursuanttotheholdingin_In_ԀreAdoptionofL.,231 x   Kan.199,643P.2d168(1982).Ifsuchfactsexist,aparagraphmaybeaddedtotheformestablishingthosefacts.Also,evenifthe_ICWA_Ԁapplies,thecourtmaydeterminethatgoodcauseexistsnottofollowtheotherwiserequiredadoptionplacementpreferences.InreAdoptionof_B.G.J._,111P.3d651(_Kan_.Ct.App.2005).  ~   c   c#XX  c'# c XXIJHHJHHJHHJHHJHHJHHJHHJHH@YY& Comments  4  # c   cA#  Becauseaparentslibertyinterestinthecustodyandcontrolofhisorherownchildrenisatstakeinan r  adoption,theadoption,relinquishmentandterminationofparentalrightsstatutesarestrictlyconstrued.InreA.W., < 241Kan.810,81415,740P.2d82,86(1987).Thereforeitiscriticaltothevalidityofanadoptionthatrequiredconsentsbevalidlyobtainedandexecutedinaccordwithallthestatutoryconditions. c   c (   Whoseconsentisrequired .Theconsentofbothparentsisrequired,unlessthecourtmakesaspecific  findingthattheconsentofoneisnotrequired,pursuanttoK.S.A.592129(a)(2).InreAdoptionofA.J.P.,24Kan. g App.2d891,892,953P.2d1387,1389(1998).  Capacitytoconsent. Aparentretainsthelegalauthoritytoconsenttoastepparentadoptionofherchild S byherspouse,evenatatimewhenguardianshipofthechildhasbeengrantedtoanotherperson.InreAdoption   ofJ.A.B.,Jr.,26Kan.App.2d959,96769,997P.2d98,10405(2000).    Acknowledgment. AlthoughKansasnotariespubliconlyhaveauthoritytoacknowledgedocuments \ withintheStateofKansas(K.S.A.53101),aconsenttoadoptionsignedinMissouribeforeaKansasnotarywasupheldasbeinginsubstantialcompliancewiththelaw.InreAdoptionofTrent,# c   cD#A c   cԀ229Kan.224,624P.2d433 K (1981).# c  A c,I#ԀTheCourtalsonotedthatwhenaconsenttoadoptionisproperlyacknowledged,theacknowledgment  servesasprimafacieproofofthevalidityoftheconsentandthatitwasfreelyandvoluntarilygiven.    Timeofbirth. In1987theKansasCourtofAppealsheldthatanaturalmother,whosignedanadoption Q  consentshortlyafterbirthofthechild,musthavetheopportunitytoprovetheconsentwasvoidorvoidablebecauseofherinabilitytofullycomprehendwhatshewasdoingduetomedicationand/orthestressandpainassociatedwiththebirth.InreAdoptionofBabyGirlH.,12Kan.App.2d223,739P.2d1(1987).Thereafter,  # in1990thelegislatureamendedtheadoptionacttoprovidethatanyconsentorrelinquishmentgivenbythemotherbefore12hoursafterbirthofthechildisvoidable,priortothefinaldecreeofadoption.TheBabyGirlH.decision F% suggeststhatthetimingconcernhadtodowiththemothersbirthexperienceanddoesnotrelatetothefather.Thestatutedoesnotrestrictthetimingofthefathersconsent,otherthanthesixmonthrequirementexplainedabove.  Ifabirthmotherdecidestoseektovoidaconsentobtainedpriorto12hoursafterthebirth,shecandosopriortotheentryofthedecreeofadoption,simplybyprovingtheconsentwasobtainedwithin12hoursafterthebirthofthechild.Afterthedecreeisentered,however,aparentcannotseektovoidtheconsent,unlessappropriateunderK.S.A.60260(b).InreAdoptionofJ.H.G.,254Kan.780,869P.2d640(1994). $%",   Theconstitutionalityofgivingmoreprotectiontobirthmotherswhosignconsentspriorto12hoursafterthebirthoftheirchildwasupheldasreasonableinInreAdoptionofBabyGirlT.,28Kan.App.2d712,72225, &`$. 21P.3d581,59092(2001).  Consentofminorparent .Whenabirthparentisaminor,theparentmusthaveindependent L(%0 representation.Onelawyercannotrepresentboththeminorbirthparentandtheadoptiveparents.InreAdoption )&1 ofN.A.P.,23Kan.App.2d257,266,930P.2d609,615(1997).TheN.A.P.decisionheldthatwhenonelawyer )'2 beginsmultiplerepresentationofboththeminorbirthparentandtheadoptiveparents,aconsentlaterobtainedwithrepresentationbyindependentcounselisnotvoided,butthetrialcourtmayconsidertheinitialmultiplerepresentationasafactorindeterminingwhethertheconsentwasfreelyandvoluntarilygiven.  Counselingbyattorney .Agoodpracticeforlawyersrepresentingparentswhoareconsentingto  -*6 adoptionoftheirchildistovideoortaperecordthesession,toprovideevidenceoftheexplanationandadvicegiventotheparent,shouldtheparentlaterclaimtheconsentwasnotfreelyandvoluntarilysigned.TheCourtin .J,8 InreAdoptionofBabyGirlT.,28Kan.App.2d712,21P.3d581(2001),notedthatalawyerrepresentingboth l/-9 theadoptiveparentsandabirthparentwouldbewelladvisedtovisitwiththebirthparentindividuallytoensurethateachclienthastheopportunitytodiscloseinformationtothelawyerwithoutfearofrecriminationfromothers.TheCourtsuggestedthatthelawyerexplaineachsectionoftheadoptionconsent,perhapsaskingthebirthparenttoinitialeachsectionasheorshereadsit.  Revocation .Aparentdoesnothavestandingtoseektochallengeaconsenttoadoptiongivenbythe ( otherparent;K.S.A.592114permitsonlytheparentgivingaconsenttolaterquestionthevalidityoftheconsent. c   cInreAdoptionofTrent,# c   cX#A c   cԀ229Kan.224,23132,624P.2d433,439(1981).# c  A cRY#    Inordertorebutthepresumptionthattheconsentwasfreelyandvoluntarilygiven,aparentmustprovefraud,duress,undueinfluence,mistakeorlackofunderstanding.InreAdoptionofChance,4Kan.App.2d576, S 583,609P.2d232,238(1980).Amisunderstandingbetweentheadoptiveparentsandthebirthmotherregardingvisitationwiththechilddoesnotnecessarilyconstitutefraud,misunderstandingorduresssufficienttovoidaconsenttoadoption.InreAdoptionofBabyGirlT.,28Kan.App.2d712,71720,21P.3d581,58789(2001).      Theburdenofproofisshiftedfromthebirthparenttotheadoptingparentswhenthereisevidencethatsomeoneinaconfidentialorfiduciaryrelationshipwiththebirthparentexertedundueinfluenceandtherearesuspiciouscircumstances,suchasafamilyrelationshipbetweenthebirthmothersphysicianandtheattorneyfortheadoptingparents.InreAdoptionofBabyBoyIrons,235Kan.540,684P.2d332(1984).Underthefactsof 1  thiscase,theCourtfoundthattheconsentwasfreelyandvoluntarilygiven.  Waiverofnoticeofproceedings .Aprovisioninaconsenttoadoptionthatwaives allnoticeof m  proceedings,isvalid,eventhoughtheparentclaimslaternottohaveknownthetimeframeinwhichtheproceedingswouldtakeplace.InreAdoptionofJ.H.G.,254Kan.780,800,869P.2d640,653(1994).#XX  cA#