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Affidavit of Person Making Placement

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Affidavit of Person Making Placement (This form replaces CCCO-0000 A1)

(Rev. 3/26/13) СССО 0007 A

IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS
COUNTY DEPARTMENT, COUNTY DIVISION

IN THE MATTER OF THE PETITION OF

and

TO ADOPT:

No.

AFFIDAVIT OF PERSON MAKING PLACEMENT (2817)

I, residing at

with or employed by a(n) affiliated arranged the placement or transmitted information concerning the availability of the child to the petitioners or their agent.

1. State in specific detail how you learned of the availability of the child?

2. What is your relation to the adopting parents? (Friend, relative, patient, etc.)
If none, how did your learn about them?

3. How did you learn the adopting parents wanted a child?

4. What expenses have you incurred or do you anticipate incurring?

ITEMIZE AMOUNT
$
$
$

(Rev.3/26/13) СССО 0007 В

5. Name any person or organization, including yourself, who has or expects to receive any fees, gifts, donation or reimbursements, directly or indirectly, from adopting parent(s) or their agent, and the reason for the payment.

ITEMIZE AMOUNT
$
$
$
$
$

6. Money gifts, donations or reimbursements paid or promised to be paid to the biological parents, whether by the adopting parents or any other persons:

ITEMIZE AMOUNT
$
$
$
$
$

CERTIFICATIONS

Under penalties as provided by law pursuant to Section 1-109 of the Code of Civil Procedure, the undersigned certify that the statements set forth in this Affidavit are true and correct.

Dated:

(Signed)

CERTIFICATION OF ATTORNEY OF RECORD

Under penalties as provided by law pursuant to Section 1-109 of the code of Civil Procedure, the undersigned certifies that s/he has read and reviewed the AFFIDAVIT OF PERSON MAKING PLACEMENT, and that the contents thereof are true and correct to the best of his/her knowledge, information and belief.

Atty. No:

(Signed)

Name:

Atty. for:

Address:

City/State/Zip:

Telephone:

Email address:

DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS

(OVER)

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What the Affidavit of Person Making Placement Is

The Affidavit of Person Making Placement is a sworn written statement by an individual who arranged or effected placement of a person or property and who attests to factual details about that placement. Commonly used in child welfare, adoption, foster-care transfers, and certain custody matters, the affidavit documents who made the placement, when and where it occurred, the parties involved, and any steps taken to notify relevant agencies. It is signed under penalty of perjury and typically requires notarization or other authentication to be admissible in court or agency records.

Why this affidavit matters for legal and administrative records

This affidavit creates a clear, contemporaneous record of placement facts that supports case files, agency decisions, and court proceedings; it reduces ambiguity about chain of custody and provides sworn evidence if disputes arise.

Why this affidavit matters for legal and administrative records

Who typically completes or relies on this affidavit

The affidavit is prepared by the person who arranged the placement and used by agencies, attorneys, or courts to confirm factual details.

  • Placement coordinators and caseworkers who arranged transfers and must document circumstances and notifications.
  • Adoptive or foster parents who received placement and need to confirm dates, contacts, and prior custody arrangements.
  • Attorneys and agency administrators who use the sworn statement as supporting evidence in filings or hearings.

Primary signer roles and what they should provide

Placement Coordinator

A caseworker, social worker, or authorized private agent who prepared and executed the placement. Provide a clear narrative of events, dates, contact information for parties and agencies, and documentation of any notifications or consents obtained; sign under oath before an authorized official.

Receiving Party

An adoptive, foster, or receiving caregiver who may co-sign or confirm receipt. Include identifying details, relationship to the person placed, and any discrepancies observed; retain copies for case records and future verification.

Key components to include in a professional affidavit

A complete affidavit of person making placement combines identifying data, a factual chronology, declarative statements of actions taken, witness or agency contacts, authentication details, and clear signature and notary blocks to support legal admissibility.

Affiant Identity

Full legal name, date of birth if relevant, current address, and relationship or authority to make the placement. This anchors who is swearing to the facts.

Placement Details

Precise date, time, and location of the placement, names and contact details of the receiving party, and any transportation or handoff circumstances that clarify custody changes.

Chronology of Events

A concise, chronological account of actions taken before, during, and after placement, including attempts to contact guardians or agencies and the reasons for placement.

Notifications and Consents

Record of any written or verbal consents obtained, persons notified (with dates), and agency referrals or case numbers associated with the placement.

Supporting Attachments

Attach relevant documents such as identification, referral letters, intake forms, or prior court orders to corroborate statements in the affidavit.

Authentication Block

Signature line for the affiant plus notary acknowledgment, date, and any witness signature lines required by jurisdiction.

Step-by-step: completing the affidavit correctly

Follow these steps in order to prepare, authenticate, and file a compliant affidavit of person making placement.

  • 01
    Prepare: Gather IDs, referral paperwork, and contact details for all parties.
  • 02
    Draft: Write a clear chronology and attach supporting documents.
  • 03
    Authenticate: Sign before a notary or follow RON procedures if permitted.
  • 04
    File: Submit to the agency, court, or record holder specified by governing rules.

How to set up a digital workflow for this affidavit

A consistent digital workflow helps capture signatures, preserve audit trails, and distribute copies to stakeholders.

Field Configuration
Affiant Signature Required signature field; allow eSign or stern verification.
Notary Block Include notary acknowledgement and date fields for in-person or RON notarization.
Attachments Set required attachment slots for IDs and referral forms.
Distribution Auto-send PDF to agency, attorney, and affiant after completion.

Typical processing flow after the affidavit is signed

Understanding the post-signature flow helps set expectations for verification and record updates.

  • Capture: Affidavit signed and notarized, digital audit trail recorded.
  • Validate: Agency or court reviews contents and supporting documents.
  • Record: Document is filed in case management or court docket.
  • Notify: Relevant parties receive certified copies or confirmations.

Digital signing and platform requirements to consider

Verify that your chosen platform supports required authentication, notarization workflows, and secure record retention before e-signing an affidavit.

  • Authentication: Email, SMS, or KBA options for signer identity verification.
  • Notarization Support: In-person notarization fields or Remote Online Notarization (RON) workflows where permitted.
  • Export & Storage: PDF/A export, audit trail, and secure cloud storage options.

Essential security and compliance considerations

Encryption: TLS 1.2/1.3 in transit; AES-256 at rest
Audit Trail: Timestamp, IP, action log retained
HIPAA: BAA available for protected health information
ESIGN / UETA: Compliant with federal/state e-sign laws
21 CFR Part 11: Support for FDA-regulated electronic records
SOC 2 / ISO: SOC 2 Type II and ISO 27001 certifications

Common pitfalls to avoid when preparing the affidavit

  • Using an informal or unsigned statement instead of a sworn affidavit, which can be inadmissible in court or agency files.
  • Entering inconsistent names or dates that do not match supporting IDs or records, triggering verification requests or rejection.
  • Failing to notarize when jurisdiction or recipient requires a notarized affidavit, delaying processing or invalidating the document.
  • Omitting attachments referenced in the affidavit, such as referral letters or intake forms, which weakens corroboration of facts.

Legal and administrative risks of incorrect or false affidavits

Perjury Exposure: Subject to state perjury laws and penalties
Case Delays: Incorrect affidavits can trigger hearings and postponements
Administrative Rejection: Agencies may refuse or return incomplete filings
Civil Liability: Potential for later civil claims or disputes
Record Integrity: Erroneous entries compromise case history and audits
Criminal Charges: Intentional falsification may lead to criminal prosecution

Timelines and deadlines to keep in mind

Timing requirements vary by agency, court, and state — confirm the deadline that applies before submitting an affidavit.

Immediate Notification:

Some agencies require placement notice within 24–72 hours of the event

Filing with Case:

Affidavit often required within days of placement to update case files

School or Healthcare Notices:

Deadlines differ; check local agency policies for time limits

Retention Start Date:

Retention begins on document creation or signature date

Extension Requests:

File early to allow time for corrections or court extensions

Key milestones from placement through final record

A sequential view of critical stages clarifies when actions and filings typically occur.

01

Event Occurs

Placement happens and immediate facts are documented

02

Affidavit Drafted

Affiant prepares sworn statement while details are fresh

03

Authentication

Affiant signs before notary or follows permitted RON steps

04

File & Distribute

Filed with agency or court and copies sent to parties

eSignature vendor pricing and capability snapshot for affidavit workflows

Compare per-user starting prices and core capabilities relevant to affidavits: free trial availability, bulk sending, audit trails, HIPAA support, and any envelope caps.

signNow DocuSign Adobe Sign PandaDoc HelloSign
Starting Price $8/user/mo $15/user/mo $14/user/mo $19/user/mo $15/user/mo
Free Trial 7-day free trial Varies by vendor Varies by vendor Varies by vendor Varies by vendor
Bulk Send Yes Yes Yes Yes No
Audit Trail Yes Yes Yes Yes Yes
HIPAA Compliant Yes Yes Yes No No
Envelope Cap No cap 100 envelopes/user/year Varies by plan Varies by plan Varies by plan

Real-world examples of affidavit use

These case outlines show typical contexts and outcomes when affidavits are prepared carefully and submitted promptly.

Child Welfare Placement

A caseworker documents emergency placement of a minor

  • Affidavit lists dates, contacts, and notifications
  • The sworn record enabled timely case review and clarified custody for the receiving agency and court.

Property Handover

A property manager records placement of keys and tenant occupancy

  • Affidavit references lease and inspection report
  • The notarized affidavit resolved a later dispute about move-in condition and responsibility.

Frequently asked questions about affidavits of placement

Answers to common concerns about validity, notarization, digital signing, and recordkeeping for the affidavit of person making placement.


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