093_SB0118eng

 
SB118 Engrossed                      LRB093 04906 LCB 04965 b

 1        AN ACT in relation to family law.

 2        Be  it  enacted  by  the People of the State of Illinois,
 3    represented in the General Assembly:

 4        Section 5.  The  Adoption  Act  is  amended  by  changing
 5    Section 18.2 as follows:

 6        (750 ILCS 50/18.2) (from Ch. 40, par. 1522.2)
 7        Sec. 18.2. Forms.
 8        (a)  The   form   of   the   Birth   Parent  Registration
 9    Identification Form shall be substantially as follows:
10              BIRTH PARENT REGISTRATION IDENTIFICATION
11                   (Insert all known information)
12    I, ....., state that I am the ...... (mother  or  father)  of
13    the following child:
14        Child's original name: ..... (first) ..... (middle) .....
15             (last),  .....  (hour  of  birth),  .....  (date  of
16             birth), ..... (city and state of birth), ..... (name
17             of hospital).
18        Father's  full name: ...... (first) ...... (middle) .....
19             (last), ..... (date of birth), ..... (city and state
20             of birth).
21        Name of  mother  inserted  on  birth  certificate:  .....
22             (first)  .....  (middle) ..... (last), ..... (race),
23             ..... (date of birth), ......  (city  and  state  of
24             birth).
25    That  I  surrendered  my  child  to:  .............  (name of
26        agency),  .....  (city  and  state  of   agency),   .....
27        (approximate date child surrendered).
28    That  I  placed  my  child by private adoption: ..... (date),
29        ...... (city and state).
30    Name of adoptive parents, if known: ......
31    Other identifying information: .....
 
SB118 Engrossed             -2-      LRB093 04906 LCB 04965 b
 1                                         ........................
 2                                            (Signature of parent)
 3    ............                         ........................
 4    (date)                               (printed name of parent)

 5        (b)  The  form  of  the   Adopted   Person   Registration
 6    Identification shall be substantially as follows:
 7                           ADOPTED PERSON
 8                     REGISTRATION IDENTIFICATION
 9                   (Insert all known information)
10    I, ....., state the following:
11        Adopted   Person's  present  name:  .....  (first)  .....
12             (middle) ..... (last).
13        Adopted Person's name at birth (if known): .....  (first)
14             .....  (middle)  .....  (last),  ..... (birth date),
15             ..... (city and state of birth), ...... (sex), .....
16             (race).
17        Name of adoptive father:  .....  (first)  .....  (middle)
18             ..... (last), ..... (race).
19        Maiden  name  of  adoptive  mother:  .....  (first) .....
20             (middle) ..... (last), ..... (race).
21        Name of birth mother  (if  known):  .....  (first)  .....
22             (middle) ..... (last), ..... (race).
23        Name  of  birth  father  (if  known): ..... (first) .....
24             (middle) ..... (last), ..... (race).
25        Name(s) at birth of  sibling(s)  having  a  common  birth
26             parent  with adoptee (if known): ..... (first) .....
27             (middle) ..... (last), .....  (race),  and  name  of
28             common  birth  parent:  ..... (first) ..... (middle)
29             ..... (last), ..... (race).
30    I was adopted through: ..... (name of agency).
31    I was adopted privately: ..... (state "yes" if known).
32    I was adopted in ..... (city and state),  .....  (approximate
33        date).
34    Other identifying information: .............
 
SB118 Engrossed             -3-      LRB093 04906 LCB 04965 b
 1                                           ......................
 2                                           (signature of adoptee)
 3    ...........                         .........................
 4    (date)                              (printed name of adoptee)

 5        (c)  The  form  of  the  Surrendered  Person Registration
 6    Identification shall be substantially as follows:
 7                   SURRENDERED PERSON REGISTRATION
 8                           IDENTIFICATION
 9                   (Insert all known information)
10    I, ....., state the following:
11        Surrendered Person's present name:  .....  (first)  .....
12             (middle) ..... (last).
13        Surrendered  Person's  name  at  birth  (if known): .....
14             (first) .....  (middle)  .....  (last),  .....(birth
15             date),  .....  (city  and  state  of  birth), ......
16             (sex), ..... (race).
17        Name of guardian father:  .....  (first)  .....  (middle)
18             ..... (last), ..... (race).
19        Maiden  name  of  guardian  mother:  .....  (first) .....
20             (middle) ..... (last), ..... (race).
21        Name of birth mother  (if  known):  .....  (first)  .....
22             (middle) ..... (last) ..... (race).
23        Name  of  birth  father  (if  known): ..... (first) .....
24             (middle) ..... (last), .....(race).
25        Name(s) at birth of  sibling(s)  having  a  common  birth
26             parent  with  surrendered  person  (if known): .....
27             (first) ..... (middle) ..... (last),  .....  (race),
28             and name of common birth parent: ..... (first) .....
29             (middle) ..... (last), ..... (race).
30    I was surrendered for adoption to: ..... (name of agency).
31    I  was  surrendered  for  adoption in ..... (city and state),
32        ..... (approximate date).
33    Other identifying information: ............
34                                 ................................
 
SB118 Engrossed             -4-      LRB093 04906 LCB 04965 b
 1                                (signature of surrendered person)
 2    ............                           ......................
 3    (date)                                (printed name of person
 4                                        surrendered for adoption)

 5        (d)  The form of the Information  Exchange  Authorization
 6    shall be substantially as follows:
 7                 INFORMATION EXCHANGE AUTHORIZATION
 8        I,  .....,  state  that I am the person who completed the
 9    Registration Identification; that I am of the  age  of  .....
10    years;  that  I  hereby  authorize  the  Department of Public
11    Health  to  give  to  my  (birth  parent)   (birth   sibling)
12    (surrendered   child)   the   following   (please  check  the
13    information authorized for exchange):
14             [  ]  1.  Only my name and last known address.
15             [  ]  2.  A copy of my  Illinois  Adoption  Registry
16        Application.
17             [  ]  3.  A copy of the original certificate of live
18        birth.
19        I  am  fully  aware  that I can only be supplied with any
20    information  about  my   (birth   parent)   (birth   sibling)
21    (surrendered  child)  if  such  person  has  duly executed an
22    Information Exchange Authorization for such information which
23    has not been revoked; that I can be contacted by writing  to:
24    .....  (own  name  or  name  of  person to contact) (address)
25    (phone number).
26        Dated (insert date).
27    ............                                   ..............
28    (witness)                                         (signature)

29        (e)  The form of the Denial of Information Exchange shall
30    be substantially as follows:
31                   DENIAL OF INFORMATION EXCHANGE
32        I, ....., state that I am the person  who  completed  the
33    Registration  Identification;  that  I am of the age of .....
 
SB118 Engrossed             -5-      LRB093 04906 LCB 04965 b
 1    years; that I hereby instruct the Department of Public Health
 2    not to give any identifying information about me to my (birth
 3    parent) (birth sibling) (surrendered child); that  I  do  not
 4    wish to be contacted.
 5        Dated (insert date).
 6    .............                                 ...............
 7    (witness)                                         (signature)

 8        (f)  The   Information  Exchange  Authorization  and  the
 9    Denial of Information Exchange shall be acknowledged  by  the
10    birth  parent,  birth sibling, adopted or surrendered person,
11    adoptive parent, or legal guardian before a notary public, in
12    form substantially as follows:
13    State of ..............
14    County of .............
15        I, a Notary Public, in and for the said  County,  in  the
16    State  aforesaid,  do  hereby  certify  that  ...............
17    personally  known  to  me to be the same person whose name is
18    subscribed to the foregoing certificate  of  acknowledgement,
19    appeared  before  me  in  person and acknowledged that (he or
20    she) signed  such  certificate  as  (his  or  her)  free  and
21    voluntary act and that the statements in such certificate are
22    true.
23        Given under my hand and notarial seal on (insert date).
24                                        .........................
25                                                 (signature)

26        (g)  When   the  execution  of  an  Information  Exchange
27    Authorization  or  a  Denial  of  Information   Exchange   is
28    acknowledged  before  a  representative  of  an  agency, such
29    representative shall have his signature on  said  Certificate
30    acknowledged before a notary public, in form substantially as
31    follows:
32    State of..........
33    County of.........
 
SB118 Engrossed             -6-      LRB093 04906 LCB 04965 b
 1        I,  a  Notary  Public, in and for the said County, in the
 2    State aforesaid, do  hereby  certify  that  .....  personally
 3    known to me to be the same person whose name is subscribed to
 4    the foregoing certificate of acknowledgement, appeared before
 5    me  in  person  and acknowledged that (he or she) signed such
 6    certificate as (his or her) free and voluntary act  and  that
 7    the statements in such certificate are true.
 8        Given under my hand and notarial seal on (insert date).
 9                                          .......................
10                                                   (signature)

11        (h)  When  an  Illinois  Adoption  Registry  Application,
12    Information Exchange Authorization or a Denial of Information
13    Exchange  is  executed in a foreign country, the execution of
14    such document shall be acknowledged  or  affirmed  before  an
15    officer of the United States consular services.
16        (i)  If   the  person  signing  an  Information  Exchange
17    Authorization or a Denial of Information is in  the  military
18    service  of the United States, the execution of such document
19    may be acknowledged before a  commissioned  officer  and  the
20    signature  of  such  officer  on  such  certificate  shall be
21    verified or acknowledged before a notary public  or  by  such
22    other  procedure  as  is  then in effect for such division or
23    branch of the armed forces.
24        (j)  The Department shall modify these forms as necessary
25    to implement the provisions of this amendatory  Act  of  1999
26    including  creating  Registration  Identification  Forms  for
27    non-surrendered  birth  siblings,  adoptive parents and legal
28    guardians.
29    (Source: P.A. 91-357, eff. 7-29-99; 91-417, eff. 1-1-00.)

30        Section 99.  Effective date.  This Act takes effect  upon
31    becoming law.