Form Ad 900b - Statement Of Understanding - Alleged Father Of An Indian Child Page 6
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6CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
_____ 21. I understand if I think I was deliberately not told the truth about having this child adopted, I have
three years after the date the adoption was completed, or within 90 days of discovery of the
fraud, whichever is earlier, to ask the court to set-aside the adoption of this child.
_____ 22. I understand I will no longer be considered this child’s legal parent once the adoption is granted
in court. This means that:
_____ a. I will no longer be responsible for the care of this child;
_____ b. The petitioner(s) will be the parent(s) and will be legally responsible for caring for this
child;
_____ c. I will no longer have any right to the custody, services, or earnings of this child; and
_____ d. I will not be able to reclaim this child.
_____ 23. I have carefully thought about the reasons for keeping or having this child adopted. I have decided
that having this child adopted by the petitioner(s) is in the best interest of this child. I have read and
understand this Statement of Understanding and the consent to adoption forms, I do not need any
more help or time to make my decision. I have decided to consent to the adoption of this child by
the petitioner(s), and I am signing this freely and willingly.
I, ___________________________________, alleged father of ___________________________________,
NAME OF ALLEGED FATHER
NAME OF CHILD
understand and agree to the statements I have initialed above.
DATE
SIGNATURE OF ALLEGED FATHER
SECTION A
Complete if signed in California
I, ______________________________________________________________, an authorized official of
NAME OF AUTHORIZED AGENCY OFFICIAL
________________________________________________________, have witnessed the signing of this
NAME OF AGENCY
Statement of Understanding by ____________________________________________on ______________.
NAME OF ALLEGED FATHER
DATE
SIGNATURE OF AUTHORIZED AGENCY OFFICIAL
TITLE
FULL ADDRESS
TELEPHONE NUMBER
SECTION B
Complete If Signed Outside Of California*
***THIS FORM MUST BE SIGNED BY A NOTARY PUBLIC WHEN SIGNED OUTSIDE OF CALIFORNIA***
The Notary Public must staple the Acknowledgement document to this form and sign and date below.
SIGNATURE OF NOTARY
DATE
*If signing outside of the United States, this section must meet the requirements of the California Civil Code Section 1183
AD 900B (5/17) ALLEGED FATHER OF INDIAN CHILD
PAGE 6 OF 6
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