I, _______________, Judge of the District Court in and for __________County, State of Oklahoma, a Court having original adoption jurisdiction, do hereby certify, that upon this day, __________personally appeared in open Court, before me, and orally and in writing executed the above and foregoing Appearance and Consent to Adoption.
In executing this acknowledgement, I further certify that the said ___________acknowledged that the person executed said consent to adoption freely and voluntarily, and that it was explained to such person by or before me, the undersigned Judge of the District Court, that in executing the consent the person was surrendering all parental authority whatsoever over the minor; and that with such explanation made to the consenting person by or before me, the undersigned Judge of the District Court, the person executed the consent, freely, voluntarily and intelligently for all uses and purposes therein set forth.
I further certify that it was explained to the consenting person that this consent is irrevocable and final except for fraud or duress and may not be revoked or set aside except and unless no Petition to Adopt is filed within nine (9) months after placement of the minor or if this or some other court decides not to terminate the rights of the other parent of the minor. I further certify that I am satisfied that the consenting person understands the consequences of an adoption; the consenting person has represented that such person has not received or been promised any money or anything of value for the giving of consent except for those payments authorized by law; the consenting person has represented that such person is not under the influence of alcohol or medication or other substance that affects the person's competence; the parent fully understood the English language and communicated in the English language at all times during said hearing, or all information was translated into the consenting person's language, and was fully understood by the person; and if the consenting person was the biological parent, such parent was advised regarding the affidavit of nondisclosure.
I, _______________, Judge of the District Court in and for __________County, State of Oklahoma, a Court having original adoption jurisdiction, do hereby certify, that upon this day, __________personally appeared in open Court, before me, and orally and in writing executed the above and foregoing Appearance and Consent to Adoption.
Okla. Stat. tit. 10, § 7503-2.4