CP&P 14-86f
(rev. 6/2006)
STATE OF NEW JERSEY
COUNTY OF {County}
)
)
)
SS.
IDENTIFIED SURRENDER AFFIDAVIT
I, {name of parent} of full age, being duly sworn according to law, upon her oath, deposes and says:
1.
I am the natural father of {name of child} born on {date} in {city and state}.
2.
I am surrendering my child, {name of child}, with the desire that {name of identified adoptive
parent} adopt her.
3.
I understand that if, for some reason, the Division does not approve {name of identified adoptive
parent} as the adoptive parent, or for any other reason said adoption by {name of identified
adoptive parent} does not occur, that these surrenders will be vacated and I will retain my
parental rights.
_________________________________________
(Signature of parent)
Sworn and subscribed to before
me this _____________ day of
_________________, 20 ____.
__________________________
Notary Public of New Jersey