An express consent or relinquishment shall be in writing, signed by the individual consenting or relinquishing, and shall state all of the following:
(1)The date, place, and time of execution.
(2)The date of birth or, if prior to birth, the expected date of birth of the adoptee and any names by which the adoptee has been known.
(3)The date of birth of the individual consenting or relinquishing and his or her relationship to the adoptee.
(4)If the right to know the identity of each petitioner has not been waived, the legal name of each petitioner, unless the document is a relinquishment of the adoptee to an agency.
(5)That the individual executing the document is voluntarily and unequivocally consenting to the adoption of the adoptee. If the individual executing the document consents t
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An express consent or relinquishment shall be in writing, signed by the individual consenting or relinquishing, and shall state all of the following:
(1) The date, place, and time of execution.
(2) The date of birth or, if prior to birth, the expected date of birth of the adoptee and any names by which the adoptee has been known.
(3) The date of birth of the individual consenting or relinquishing and his or her relationship to the adoptee.
(4) If the right to know the identity of each petitioner has not been waived, the legal name of each petitioner, unless the document is a relinquishment of the adoptee to an agency.
(5) That the individual executing the document is voluntarily and unequivocally consenting to the adoption of the adoptee. If the individual executing the document consents to the adoption of the adoptee by only a designated individual or married couple, the express consent shall specify that the consent applies only to that individual or married couple, as identified by his, her, or their legal names and that the express consent shall not be construed to apply to any other individual seeking to adopt the adoptee.
(6) That by signing the document, the individual executing the document understands that, except as otherwise provided in this chapter, upon the entry of the final judgment of adoption, he or she forfeits all rights and obligations to the adoptee and that he or she understands the express consent or relinquishment and executes it freely and voluntarily.
(7) That the individual signing the document has been advised and understands that his or her express consent or relinquishment may be withdrawn only in the manner, and within the time periods, as provided in Sections 26-10E-13 and 26-10E-14, and that the adoption may not be collaterally attacked after the entry of the final judgment of adoption, except as authorized in this chapter.
(8) That the individual signing the document understands that the express consent may become irrevocable, and that the individual should not execute it if he or she needs or desires psychological or legal advice, guidance, or counseling.
(9) The address of the court in which the petition for adoption has been or will be filed, if known, and if not known, the name and address of the agency, any petitioner, or the attorney of any petitioner on whom notice of the withdrawal or relinquishment of express consent may be served.
(10) In the case of relinquishment, the name and address of the agency to which the adoptee has been relinquished.
(11) That the individual executing the document has received or has been offered a copy of the express consent or relinquishment and withdrawal form.
(12) That the individual executing a relinquishment waives further notice of the adoption proceeding.
(13) That the individual executing an express consent waives further notice of the adoption proceedings unless there is a contest or appeal of the adoption proceeding.