(b) The petitioners in an adoption proceeding are entitled to rely upon a sworn statement of the biological mother of the child to be adopted identifying the father of her child. The affidavit shall be conclusive evidence as to the biological mother regarding the facts stated therein, and shall create a rebuttable presumption of truth as to the biological father only. Except as provided in Section 11 of this Act, the biological mother of the child shall be permanently barred from attacking the proceeding thereafter. The biological mother, including a biological mother who is a petitioner, shall execute such affidavit in writing and under oath. The affidavit shall be executed by the biological mother before or at the time of execution of the consent or surrender, and shall be retained by the court and be a part of the Court's files. The form of affidavit shall be substantially as follows: AFFIDAVIT OF IDENTIFICATION
I,................., the mother of a (male or female) child, state under oath or affirm as follows:
(1) That the child was born, or is expected to be born, on (insert date), at......................., in the State of...................(2) That I reside at.................., in the City or Village of..........., State of...................(3) That I am of the age of....... years.(4) That I acknowledge that I have been asked to identify the father of my child.(5) (CHECK ONE) .... I know and am identifying the biological father.
.... I do not know the identity of the biological father.
.... I am unwilling to identify the biological father.
(6A) If I know and am identifying the father: That the name of the biological father is....................; his last known home address is............; his last known work address is....................; and he is..... years of age; or he is deceased, having died on (insert date) at.............., in the State of..................
(6B) If I do not know the identity of the biological father: I do not know who the biological father is; the following is an explanation of why I am unable to identify him:...................................................................................................................................................................................
(6C) If I am unwilling to identify the biological father: I do not wish to name the biological father of the child for the following reasons:....................................................................................................................................................................................
(7) (CHECK ONE) .... I am married to the biological father.
.... I am not and have not been married to the biological father within 300 days of the child's birth.
.... The child has another legal parent who is not the biological parent (please explain): ....................................................................................................................................................................................
(8) Regarding whether a court order has been entered by any court finding any person to be the biological father or legal parent of the child: (CHECK ONE) .... No, a court order has not been entered.
.... Yes, a court order has been entered and it is Case No.
..... in the Circuit Court located in............... County (if the case number and county is known).
.... I do not know whether there are any court or other proceedings related to a finding of any person to be the biological father or legal parent of the child.
(9) The physical description of the biological father is:..................................................................................................................................................................................(10) I reaffirm that the information contained in this Affidavit is true and correct.(11) I have been informed and understand that if I am unwilling, refuse to identify, or misidentify the biological father of the child, absent fraud or duress, I am permanently barred from attacking the proceedings for the adoption of the child at any time after I sign a final and irrevocable consent to adoption or surrender for purposes of adoption.(12) I have read this Affidavit and have had the opportunity to review and question it; it was explained to me by............................; and I am signing it as my free and voluntary act and understand the contents and the results of signing it. Dated (insert date).
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Signature
Under penalties as provided by law under Section 1-109 of the Code of Civil Procedure, the undersigned certifies that the statements set forth in this Affidavit are true and correct.
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Signature