Free State of Minnesota - Minnesota


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State: Minnesota
Category: Court Forms - State
Author: ChristineSalaba
Word Count: 473 Words, 2,876 Characters
Page Size: Letter (8 1/2" x 11")
URL

http://www.courts.state.mn.us/forms/public/forms/Adoption/Father%27s_Adoption_Registry/ADO104.pdf

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State of Minnesota County Select County
In the Matter of:
Petitioner

District Court Judicial District: Court File Number: Case Type

Family Court

vs.
Respondent

INTENT TO CLAIM PARENTAL RIGHTS

I, 1. 2. I am _______ years of age; and reside at

, state as follows:

(Street Address)

(City)

(State)

(County)

I have been advised _____________________________ is the mother of a ______________ child
(Male/Female)

named ____________________________ born or expected to be born on _________________. 3. 4. I declare I am the father. I understand the mother wishes to consent to the adoption of this child. I do not consent to the adoption of this child, and I understand I must return this form to the court administrator within 30 days of receiving the adoption registry notice. I further understand I must bring a paternity action under the Parentage Act (Minn. Stat. §§ 257.51 to 257.74) within 30 days of receiving the adoption registry notice, or, if the child is not yet born, within 30 days after the birth of the child, unless I am unable to do so. I understand a paternity action is separate from the mailing of this form. In the paternity action, I must state I am the father of the child for one or more of the reasons stated in Minn. Stat. § 257.55, subd. 1. I intend to retain my legal rights with respect to the child, and request to be notified of any further proceedings with respect to custody or adoption of the child. I enter my appearance in this case.

5.

6.

DO NOT SIGN UNTIL YOU ARE BEFORE A NOTARY PUBLIC OR COURT ADMINISTRATOR.

OATH I have been sworn and say under oath I have read and understand this form. The facts it contains are true and correct to the best of my knowledge, and I understand that by signing this document I admit paternity. I have signed this document freely and voluntarily. Subscribed and sworn to before me this _________ of _____________, _______ Signature:
Sign only in presence of notary or court clerk

Print Name: Notary Public/Court Deputy Street Address: City/State/Zip: Telephone:

ADO104

State

ENG

Rev 5/08

www.mncourts.gov/forms

Page 1 of 2

ACKNOWLEDGEMENT Pursuant to Minn. Stat. § 549.211, the undersigned acknowledges that costs, disbursements, and reasonable attorney and witness fees may be awarded to the opposing party or parties for actions in bad faith; the assertion of a claim or a defense that is frivolous and that is costly to the other party; the assertion of an unfounded position solely to delay the ordinary course of the proceedings or to harass; or the commission of a fraud upon the Court.

Subscribed and sworn to before me this _________ of _____________, _______

Signature:
Sign only in presence of notary or court clerk

Print Name: Street Address:

Notary Public/Court Deputy

City/State/Zip: Telephone:

ADO104

State

ENG

Rev 5/08

www.mncourts.gov/forms

Page 2 of 2