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Petition To Establish Parent And Child Relationship By Consent Of The Parties Form - Dekalb County, Illinois Page 3

AFFIDAVIT

STATE OF ILLINOIS

)

) SS.

COUNTY OF _______________________ )

_________________________________________________________ being first duly sworn on oath, deposes and states that

he/she is the Petitioner in the above matter and that the foregoing Petition is true and correct.

____________________________________________________

_______________________________

Print or Type Name

Subscribed and sworn to before me this ________ day

of _____________________, 20 ________.

____________________________________________

Circuit Court Clerk - Notary Public

CONSENT - APPEARANCE - WAIVER

_____________________________________________________________ being first duly sworn upon oath, deposes and

states that he/she has read the Petition and that the facts are true and correct and that by his/her signature below hereby consents

to the entry of the Proposed Order of Child/Parent Relationship, waives service of process, enters a general appearance and

waives trial by jury on the issue of parentage.

__________________________________________________

_______________________________

Print or Type Name

Subscribed and sworn to before me this ________ day

of _____________________, 20 ________.

____________________________________________

Circuit Court Clerk - Notary Public

Name: _____________________________________

Attorney No.: _____________________________________

Attorney for: _____________________________________

Address: _____________________________________

City/State/Zip: _____________________________________

Telephone: _____________________________________

C:\forms\fa000004.fam

Rev: 8/5/09

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Petition To Establish Parent And Child Relationship By Consent Of The Parties Form - Dekalb County, Illinois Page 3