Affidavit Of Voluntary Relinquishment Of Parental Rights - Texas District Court Page 9

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“I am ready emotionally and in every other way to make the decision I am making today.
“I am signing this affidavit in the presence of the two undersigned witnesses, each of whom
is known by me to be a credible person and each of whom is present and acting as a witness. I
want them to be here and to witness my signature.
“I am also signing this affidavit before a notary public, who has asked me under oath
whether or not each and every statement in this affidavit is true and correct and has advised me not
to sign it unless it is correct.
“I REALIZE THAT I SHOULD NOT SIGN THIS AFFIDAVIT UNTIL I HAVE READ
AND UNDERSTOOD EACH WORD, SENTENCE, AND PARAGRAPH IN IT. I REALIZE
THAT I SHOULD NOT SIGN THIS AFFIDAVIT OF RELINQUISHMENT IF THERE IS ANY
THOUGHT IN MY MIND THAT I MIGHT SOMEDAY SEEK TO CHANGE MY MIND AND
SEEK TO GAIN CUSTODY OF MY CHILD. AT THE TIME OF SIGNING THIS
AFFIDAVIT FOR VOLUNTARY RELINQUISHMENT OF PARENTAL RIGHTS, I FEEL
THAT I AM PHYSICALLY AND EMOTIONALLY PREPARED TO SIGN THIS
DOCUMENT. I AM NOT CURRENTLY UNDER THE INFLUENCE OF ANY SUBSTANCE
AND/OR MEDICATION THAT WOULD AFFECT MY ABILITY TO EXECUTE THIS
AFFIDAVIT.
“I ACKNOWLEDGE THAT I AM SIGNING THIS AFFIDAVIT FOR VOLUNTARY
RELINQUISHMENT OF PARENTAL RIGHTS MORE THAN FORTY-EIGHT HOURS
AFTER THE BIRTH OF THE CHILD NAMED IN THIS AFFIDAVIT.
“I hereby acknowledge receipt of a copy of this Affidavit of Relinquishment of Parental
Rights.
Signed on
.

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