Petition To Establish Parent And Child Relationship By Consent Of The Parties Form - Dekalb County, Illinois
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3IN THE CIRCUIT COURT OF THE SIXTEENTH JUDICIAL CIRCUIT
DEKALB COUNTY, ILLINOIS
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Case No.:___________________________
st
_____________________________________,
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1
Court Date:_______________________
Petitioner,
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Time:_______________________________
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vs.
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_____________________________________,
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Respondent.
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PETITION TO ESTABLISH PARENT AND CHILD
RELATIONSHIP BY CONSENT OF THE PARTIES
Now comes the Petitioner, ____________________________________________________________, pursuant to
Illinois Revised Statutes, Chapter 40, Sec. 2501 et seq. and moves this Honorable Court to establish the parent and child
relationship by consent of the parties and in support thereof states as follows:
1.
Name of Child: ________________________________________________________________
Address/City/State/Zip: ________________________________________________________________
Place of Birth: ________________________________________________________________
Date of Birth: ________________________________________________________________
2. Name of Child’s Natural Mother: ________________________________________________________________
Address/City/State/Zip: ________________________________________________________________
Place of Birth: ________________________________________________________________
Date of Birth: ________________________________________________________________
3.
Name of Child’s Natural Father: ________________________________________________________________
Address/City/State/Zip: ________________________________________________________________
Place of Birth: ________________________________________________________________
Date of Birth: ________________________________________________________________
4. [ ] Check this box if a public agency is providing assistance to the child.
Name of Agency: _______________________________________________________________________
Address/City/State/Zip: _______________________________________________________________________
5. That the parents of said child are not now nor have they at any time been married to one another, but it is in the best interest
of the minor child that ____________________________________________________________ be determined to be the
father of the child and that a parent/child relationship be established.
CHECK THIS BOX IF YOU WANT THE COURT
TO MAKE A CHILD CUSTODY DETERMINATION
6. [ ] THAT THE PETITIONER FURTHER MOVES THE COURT to determine that it has jurisdiction pursuant to Section
2104, of the Illinois Uniform Child Custody Jurisdiction Act and to award temporary custody to
_________________________________________ or establish visitation rights with regard to the minor child in
accordance with the standards set forth in Part V & VI of the I.M.D.M.A. and in support thereof states:
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