093_SB0118sam001

 










                                     LRB093 04906 LCB 12292 a

 1                    AMENDMENT TO SENATE BILL 118

 2        AMENDMENT NO.     .  Amend Senate Bill 118  by  replacing
 3    everything after the enacting clause with the following:

 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),
 
                            -2-      LRB093 04906 LCB 12292 a
 1             .....  (date  of  birth),  ...... (city and state of
 2             birth).
 3    That I  surrendered  my  child  to:  .............  (name  of
 4        agency),   .....   (city  and  state  of  agency),  .....
 5        (approximate date child surrendered).
 6    That I placed my child by  private  adoption:  .....  (date),
 7        ...... (city and state).
 8    Name of adoptive parents, if known: ......
 9    Other identifying information: .....
10                                         ........................
11                                            (Signature of parent)
12    ............                         ........................
13    (date)                               (printed name of parent)

14        (b)  The   form   of   the  Adopted  Person  Registration
15    Identification shall be substantially as follows:
16                           ADOPTED PERSON
17                     REGISTRATION IDENTIFICATION
18                   (Insert all known information)
19    I, ....., state the following:
20        Adopted  Person's  present  name:  .....  (first)   .....
21             (middle) ..... (last).
22        Adopted  Person's name at birth (if known): ..... (first)
23             ..... (middle) .....  (last),  .....  (birth  date),
24             ..... (city and state of birth), ...... (sex), .....
25             (race).
26        Name  of  adoptive  father:  ..... (first) ..... (middle)
27             ..... (last), ..... (race).
28        Maiden name  of  adoptive  mother:  .....  (first)  .....
29             (middle) ..... (last), ..... (race).
30        Name  of  birth  mother  (if  known): ..... (first) .....
31             (middle) ..... (last), ..... (race).
32        Name of birth father  (if  known):  .....  (first)  .....
33             (middle) ..... (last), ..... (race).
34        Name(s)  at  birth  of  sibling(s)  having a common birth
 
                            -3-      LRB093 04906 LCB 12292 a
 1             parent with adoptee (if known): ..... (first)  .....
 2             (middle)  .....  (last),  .....  (race), and name of
 3             common birth parent: .....  (first)  .....  (middle)
 4             ..... (last), ..... (race).
 5    I was adopted through: ..... (name of agency).
 6    I was adopted privately: ..... (state "yes" if known).
 7    I  was  adopted in ..... (city and state), ..... (approximate
 8        date).
 9    Other identifying information: .............
10                                           ......................
11                                           (signature of adoptee)
12    ...........                         .........................
13    (date)                              (printed name of adoptee)

14        (c)  The form  of  the  Surrendered  Person  Registration
15    Identification shall be substantially as follows:
16                   SURRENDERED PERSON REGISTRATION
17                           IDENTIFICATION
18                   (Insert all known information)
19    I, ....., state the following:
20        Surrendered  Person's  present  name: ..... (first) .....
21             (middle) ..... (last).
22        Surrendered Person's name  at  birth  (if  known):  .....
23             (first)  .....  (middle)  .....  (last), .....(birth
24             date), .....  (city  and  state  of  birth),  ......
25             (sex), ..... (race).
26        Name  of  guardian  father:  ..... (first) ..... (middle)
27             ..... (last), ..... (race).
28        Maiden name  of  guardian  mother:  .....  (first)  .....
29             (middle) ..... (last), ..... (race).
30        Name  of  birth  mother  (if  known): ..... (first) .....
31             (middle) ..... (last) ..... (race).
32        Name of birth father  (if  known):  .....  (first)  .....
33             (middle) ..... (last), .....(race).
34        Name(s)  at  birth  of  sibling(s)  having a common birth
 
                            -4-      LRB093 04906 LCB 12292 a
 1             parent with surrendered  person  (if  known):  .....
 2             (first)  .....  (middle) ..... (last), ..... (race),
 3             and name of common birth parent: ..... (first) .....
 4             (middle) ..... (last), ..... (race).
 5    I was surrendered for adoption to: ..... (name of agency).
 6    I was surrendered for adoption in  .....  (city  and  state),
 7        ..... (approximate date).
 8    Other identifying information: ............
 9                                 ................................
10                                (signature of surrendered person)
11    ............                           ......................
12    (date)                                (printed name of person
13                                        surrendered for adoption)

14        (d)  The  form  of the Information Exchange Authorization
15    shall be substantially as follows:
16                 INFORMATION EXCHANGE AUTHORIZATION
17        I, ....., state that I am the person  who  completed  the
18    Registration  Identification;  that  I am of the age of .....
19    years; that I  hereby  authorize  the  Department  of  Public
20    Health   to   give  to  my  (birth  parent)  (birth  sibling)
21    (surrendered  child)  the   following   (please   check   the
22    information authorized for exchange):
23             [  ]  1.  Only my name and last known address.
24             [  ]  2.  A  copy  of  my Illinois Adoption Registry
25        Application.
26             [  ]  3.  A copy of the original certificate of live
27        birth.
28        I am fully aware that I can only  be  supplied  with  any
29    information   about   my   (birth   parent)  (birth  sibling)
30    (surrendered child) if  such  person  has  duly  executed  an
31    Information Exchange Authorization for such information which
32    has  not been revoked; that I can be contacted by writing to:
33    ..... (own name or  name  of  person  to  contact)  (address)
34    (phone number).
 
                            -5-      LRB093 04906 LCB 12292 a
 1        Dated (insert date).
 2    ............                                   ..............
 3    (witness)                                         (signature)

 4        (e)  The form of the Denial of Information Exchange shall
 5    be substantially as follows:
 6                   DENIAL OF INFORMATION EXCHANGE
 7        I,  .....,  state  that I am the person who completed the
 8    Registration Identification; that I am of the  age  of  .....
 9    years; that I hereby instruct the Department of Public Health
10    not to give any identifying information about me to my (birth
11    parent)  (birth  sibling)  (surrendered child); that I do not
12    wish to be contacted.
13        Dated (insert date).
14    .............                                 ...............
15    (witness)                                         (signature)

16        (f)  The  Information  Exchange  Authorization  and   the
17    Denial  of  Information Exchange shall be acknowledged by the
18    birth parent, birth sibling, adopted or  surrendered  person,
19    adoptive parent, or legal guardian before a notary public, in
20    form substantially as follows:
21    State of ..............
22    County of .............
23        I,  a  Notary  Public, in and for the said County, in the
24    State  aforesaid,  do  hereby  certify  that  ...............
25    personally known to me to be the same person  whose  name  is
26    subscribed  to  the foregoing certificate of acknowledgement,
27    appeared before me in person and  acknowledged  that  (he  or
28    she)  signed  such  certificate  as  (his  or  her)  free and
29    voluntary act and that the statements in such certificate are
30    true.
31        Given under my hand and notarial seal on (insert date).
32                                        .........................
33                                                 (signature)
 
                            -6-      LRB093 04906 LCB 12292 a
 1        (g)  When  the  execution  of  an  Information   Exchange
 2    Authorization   or   a  Denial  of  Information  Exchange  is
 3    acknowledged before  a  representative  of  an  agency,  such
 4    representative  shall  have his signature on said Certificate
 5    acknowledged before a notary public, in form substantially as
 6    follows:
 7    State of..........
 8    County of.........
 9        I, a Notary Public, in and for the said  County,  in  the
10    State  aforesaid,  do  hereby  certify  that ..... personally
11    known to me to be the same person whose name is subscribed to
12    the foregoing certificate of acknowledgement, appeared before
13    me in person and acknowledged that (he or  she)  signed  such
14    certificate  as  (his or her) free and voluntary act and that
15    the statements in such certificate are true.
16        Given under my hand and notarial seal on (insert date).
17                                          .......................
18                                                   (signature)

19        (h)  When  an  Illinois  Adoption  Registry  Application,
20    Information Exchange Authorization or a Denial of Information
21    Exchange is executed in a foreign country, the  execution  of
22    such  document  shall  be  acknowledged or affirmed before an
23    officer of the United States consular services.
24        (i)  If  the  person  signing  an  Information   Exchange
25    Authorization  or  a Denial of Information is in the military
26    service of the United States, the execution of such  document
27    may  be  acknowledged  before  a commissioned officer and the
28    signature of  such  officer  on  such  certificate  shall  be
29    verified  or  acknowledged  before a notary public or by such
30    other procedure as is then in effect  for  such  division  or
31    branch of the armed forces.
32        (j)  The Department shall modify these forms as necessary
33    to  implement  the  provisions of this amendatory Act of 1999
34    including  creating  Registration  Identification  Forms  for
 
                            -7-      LRB093 04906 LCB 12292 a
 1    non-surrendered birth siblings, adoptive  parents  and  legal
 2    guardians.
 3    (Source: P.A. 91-357, eff. 7-29-99; 91-417, eff. 1-1-00.)

 4        Section  99.  Effective date.  This Act takes effect upon
 5    becoming law.".