Rule 118 - Affidavits or Declarations Required in Doctor and Other Third Person Placement Cases, and when Mother's Affidavit or Declaration Is Required(a) Attorney's affidavit of birth background. In every adoption where placement through a doctor or other qualified non-agency person, is made of a child with proposed adoptive parents to whom the child bears no relationship, the attorney for the petitioner or petitioners shall, before or at the time of the hearing of the petition, file an Affidavit or Declaration of Birth Background with the court containing in substance the following information: (1) the name and age of the natural mother and the name and age of the natural father, if known;(2) the name of the child at birth and the place and date of birth; (3) the marital status of the natural mother at the time of the birth of the child; (4) the racial backgrounds, physical descriptions, educational backgrounds, occupations, religion and health backgrounds of the natural mother and the natural father; (5) special requests of either parent relating to placement, if any;(6) whether or not counseling was provided either parent or reason none was obtained; (7) the total number of times the attorney saw the natural mother and information regarding the consistency of her indicated desire to place the child in the manner proposed; and (8) if the natural mother is an unmarried minor, the name and relationship of the person endorsing her consent, if an endorsement is made. (b) Natural mother's affidavit or declaration of relationship with natural father. In every adoption in which the child sought to be adopted is born out of wedlock where the natural father who has notice of the birth or expected birth of the child has not given his written consent, in order for the court to determine whether the consent of the natural father is not required or may be dispensed with or whether or not notice of the adoption proceeding must be given to the natural father, the natural mother shall, before the hearing, sign an affidavit or declaration containing the following information regarding her relationship with the natural father: (1) whether or not the natural father knew about or was told of the pregnancy and/or the birth of the child;(2) whether or not the natural mother and the natural father cohabited with each other before or after the birth of the child and, if so, for what duration; (3) whether or not the natural father contributed toward the hospital and medical expenses in connection with the birth of the child and, if so, how much and, if he did not, who did pay such expenses;(4) whether or not the natural father has contributed toward the support of the child and, if so, to what extent and, if not, who did support said child; (5) whether or not the natural mother filed any paternity action against the alleged natural father and, if so, whether or not the alleged natural father was adjudicated to be the natural father of the child; and(6) whether or not the name of father appears on the child's birth certificate. The affidavit or declaration shall be presented to the judge for review prior to the filing of the petition.(c) Foreign adoption placement agency's affidavit or declaration. In an adoption where placement is made of a child through a foreign adoption agency, and the mother's affidavit or declaration, as required by (b), is not obtainable, the foreign adoption agency, which placed the child, may submit an affidavit or declaration containing the following: (1) information the agency possesses relating to the relationship between the natural mother and the natural father; (2) how the agency possesses this information; (3) whether or not the natural father ever attempted to contact the child while the child was in the custody of the agency; and(4) the attempts made by the agency to contact the natural mother to secure the affidavit or declaration required by (b). The local adoption agency which placed the child with the adoptive parents, in conjunction with the foreign adoption agency, shall submit the affidavit or declaration to the judge for review, together with its report and documents relating to the child to be adopted.
Amended July 1, 1982, effective 7/1/1982; further amended October 11, 1999, effective 1/1/2000; further amended November 20, 2014, effective 1/1/2015.