Fill and Sign the Code Awca Form

IN THE INTEREST OF: _____________________________________________, a child Respondent _______________________________________________ Address _______________________________________________ _______________________________________________ AOC-292 Doc. Code: AWCA Rev. 6-17Page 1 of 2 Commonwealth of Kentucky Court of Justice www.courts.ky.gov KRS 625.041(3); 199.011(16); and 199.500 APPEARANCE WAIVER AND CONSENT TO ADOPTION lexet justitia COMMONWEALTHOFKENTUCKY COURTOFJUSTICE Case No. ____________________ Court q District q Family County ____________________ Division ____________________ WAIVER OF APPEARANCE I, ___________________________________________________________, hereby state that I am the natural parent of the above-named child and I hereby voluntarily, and with full knowledge and agreement, waive my right to appear in the above-styled proceeding to terminate my parental rights. _______________________________________________ Parent's Signature _______________________________________________ Parent's Name (Please Print) _______________________________________________Counsel for Parent _______________________________________________ Guardian ad litem for Minor Parent _______________________________________________ Cabinet Designee SUBSCRIBED and SWORN to before me this ___________ day of _______________________________, 2_______. My Commission expires: ___________________________. ____________________________________________ Notary Public q Please mail a copy of the FINAL JUDGMENT to: _______________________________________________________________________________________________ _____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Preparer's Name & Address __________________________________________ ____________________________________________________________________________________ AOC-292 Rev. 6-17Page 2 of 2 I, ______________________________________________, hereby state that I am the natural q mother q father of _______________________________________________, the child to be adopted, who was born to me q in wedlock q out-of-wedlock on __________________ in ________________________________________________________.CONSENT TO ADOPTION (parent's name) (child's name) (child's date of birth) (city, state, country of child's birth) I also state, and acknowledge by my initials, that: _____ I do not desire to know the identi�cation of the proposed adoptive parent(s) of my child; or _____ The proposed adoptive parent of my child is:______________________________________________. _____ I understand that if the adoption is not adjudged, that the disposition of my child will be made pursuant to KRS 199.550. _____ The total amount of my legal fees related to the execution of this consent are $__________________ to be paid by_______________________________________. _____ That I have reviewed this consent and the legal effect of this consent has been fully explained to me. _____ That I have not been coerced in any way to execute this consent, nor have I been given or promised anything of value, except those expenses allowable under KRS 199.590(6), to execute this consent. _____ That it is my intention to consent to the adoption of my child. I understand that this consent to the adoption of my child will become �nal and irrevocable twenty (20) days after the later of the placement approval (if required by the secretary for families and children) or the execution of this consent and that this consent may be withdrawn only by written noti�cation sent to the proposed adoptive parent or the attorney for the proposed adoptive parent on or before the twentieth day by certi�ed or registered mail and also by �rst class mail. If placement approval by the secretary is not required, the voluntary and informed consent shall become �nal and irrevocable twenty (20) days after execution. I hereby acknowledge, by my signature, executed this ______ day of _________________________, 2______ in ___________________________, __________________________ County, Kentucky at __________ q a.m. q p.m. that I have voluntarily and knowingly given my informed consent to the adoption of my child. ____________________________________________ Consenting Parent's Signature I received a completed and signed copy of this consent on the same day I signed it. ____________________________________________ Consenting Parent's Signature SUBSCRIBED and SWORN to before me this ___________ day of _______________________________, 2_______. My Commission expires: __________________________. ____________________________________________ Notary Public Reviewer's Name & Address __________________________________________ ____________________________________________________________________________________ SUBSCRIBED and SWORN to before me this ___________ day of _______________________________, 2_______. My Commission expires: __________________________. ____________________________________________ Notary Public