Form CFS403-B "Affidavit of Identification" - Illinois

What Is Form CFS403-B?

This is a legal form that was released by the Illinois Department of Children and Family Services - a government authority operating within Illinois. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on November 1, 2005;
  • The latest edition provided by the Illinois Department of Children and Family Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form CFS403-B by clicking the link below or browse more documents and templates provided by the Illinois Department of Children and Family Services.

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Download Form CFS403-B "Affidavit of Identification" - Illinois

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CFS 403-B
Rev 11/2005
State of Illinois
Department of Children and Family Services
AFFIDAVIT OF IDENTIFICATION
I,
, the mother of
a
male
female child (please check one), state that:
1)
My child
was born on
,
at
Hospital in
County in the State of
.
2.
That I reside at
, in the City or Village
of
, State of
.
3.
That I am
years of age.
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 (see 6A)
I do not know the identity of the biological father (see 6B)
I am unwilling to identify the biological father (see 6C)
6A.
The name of the biological father is
His last known home address is
His last known work address is
(Include name of employer, if known)
He is
years of age, or he is deceased, having died on the
day of
,
, at
, in the State of
.
6B.
I do not know who the biological father is. The following is an explanation of why I am
unable to identify him:
6C.
I do not wish to name the biological father of the child for the following reason/s:
7.
The physical description of the biological father is:
Race
Mustache/Beard
Hair
Complexion
Height
Weight
Glasses
Other
Tattoos/scars
(Including type & location on body)
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CFS 403-B
Rev 11/2005
State of Illinois
Department of Children and Family Services
AFFIDAVIT OF IDENTIFICATION
I,
, the mother of
a
male
female child (please check one), state that:
1)
My child
was born on
,
at
Hospital in
County in the State of
.
2.
That I reside at
, in the City or Village
of
, State of
.
3.
That I am
years of age.
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 (see 6A)
I do not know the identity of the biological father (see 6B)
I am unwilling to identify the biological father (see 6C)
6A.
The name of the biological father is
His last known home address is
His last known work address is
(Include name of employer, if known)
He is
years of age, or he is deceased, having died on the
day of
,
, at
, in the State of
.
6B.
I do not know who the biological father is. The following is an explanation of why I am
unable to identify him:
6C.
I do not wish to name the biological father of the child for the following reason/s:
7.
The physical description of the biological father is:
Race
Mustache/Beard
Hair
Complexion
Height
Weight
Glasses
Other
Tattoos/scars
(Including type & location on body)
1 of 2
8.
I reaffirm that the information contained in points 5, 6 and 7 is true and correct.
9.
I have been informed and understand that if I am unwilling, refuse to identify, or
misidentify the biological father of this child, absent fraud or duress, that 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 by a specified
person or persons, or surrender for purposes of adoption.
10.
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.
Date:
/
/20
Signature of Mother
Under penalties as provided by law under Section 1-109 of the Code of Civil Procedure
which states that if I knowingly make a false statement, I may be subjected to
prosecution for a class 3 felony which is punishable by imprisonment for two to five
years, the undersigned certifies that the statements set forth in this Affidavit are true and
correct.
Signature of Mother
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