Fill and Sign the Termination Parental Rights 497431081 Form

For Official Use STATE OF WISCONSIN, CIRCUIT COURT,       COUNTY IN THE INTEREST OF       a person under the age of 18 . Consent to Termination of Parental Rights (Judicial)       Date of Birth Case No.       Under oath, I state: 1. My name is       My address is       My date of birth is       2. I am the (check one) alleged adjudicated natural (check one) father mother of this child This child was was not born during a marriage between myself and the other parent. 3. I have been informed and understand that a court order terminating parental rights will permanently end ALL legal rights and duties that exist between myself and this child, such as:  Duty to support  Right to custody and visitation  Right to inherit 4. I wish to give up any parental rights that I may have to this child and consent to the court entering an order terminating my parental rights. 5. I give up the right to know of any future hearing or proceedings in this matter. 6. I am making this decision on my own free will. No promises or threats have been made to get me to sign this document. Subscribed and sworn to before me on       Notary Public, State of Wisconsin My commission expires:       _____________________________________________ Signature       Name Printed or Typed       Date APPROVAL OF GUARDIAN AD LITEM (Needed for minor or incompetent parent) I am the guardian ad litem for the above named parent who is a minor incompetent. I am familiar with the facts. I join in the consent to the termination of this person’s parental rights. CERTIFICATE OF JUDGE I certify that I am the judge of the       court of       County, State of       , a court of record. The above named parent appeared before me on this date. I questioned this parent and found this consent to be informed and voluntary before I accepted it. _____________________________________________ Signature of Guardian ad Litem       Name Printed or Typed       Date Signature of Circuit Court       Name Printed or Typed       Date JC-1637, 11/99 Consent to Termination of Parental Rights (Judicial) 48.41(2)(b), Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material.