4-986

[Kinship Guardianship Act, Sections

40-10B-1 to 40-10B-14 NMSA 1978]

STATE OF NEW MEXICO

COUNTY OF _______________

___________________ JUDICIAL DISTRICT

                                                                                                No. ____________

_____________________________, Petitioner²

v.

_______________ and ______________, Respondents³

IN THE MATTER OF THE GUARDIANSHIP

OF ________________________________

PARENTAL CONSENT TO APPOINTMENT OF GUARDIAN

AND WAIVER OF SERVICE OF PROCESS

(Paternity not admitted)

I __________________________ (name of parent) upon my oath or affirmation state:

1.         RESPONDENT

I, _______________________ (list name), am a respondent in the above case and without admitting that I am the father of:

Name: ___________________________________________ (Last name, first and middle)

Date of birth: ___________________________________

Present address:

________________________________ (street)

________________________________ (city)

________________________________ (state and zip code)

I agree to the relief requested by the petitioners in the Petition for Order Appointing Kinship Guardian, a copy of which has been provided to me with this consent form.

2.         MY AGREEMENT

I understand that by signing this paper:

            A.        I am giving the petitioners any legal rights and duties I have if it is later established that I am the father of the child;

            B.        if it is later determined that I am the father of the above child, I may be required to pay child support;

            C.        I will have no rights to visitation of the above child; and

            D.        if I want to terminate the kinship guardianship of the above child, I will have to prove that the circumstances surrounding the signing of this paper have changed and that it is in the best interest of my [child] [children] that the guardianship be terminated.

3.         WAIVER OF RIGHT TO SERVICE OF SUMMONS AND PETITION

I have copies of the Petition for Order Appointing Kinship Guardian filed in this case and waive service of the summons and additional pleadings.

I have not been given anything in exchange for signing this consent form.

4.         RIGHT NOT TO SIGN

I UNDERSTAND THAT I DO NOT HAVE TO SIGN THIS CONSENT FORM AND THAT I HAVE THE RIGHT TO CONTEST THIS ACTION. I AM KNOWINGLY AND VOLUNTARILY SIGNING THIS FORM.

When I sign below, I am telling the judge that I have read this document and agree with everything in it. I state upon my oath or affirmation that this document and the statements in it are true and correct to the best of my information and belief.

5.         RIGHT TO WITHDRAW CONSENT

I understand that I may withdraw this consent at any time before the court enters an order granting the petition for kinship guardianship by filing with the court a motion notifying the court of my withdrawal of consent.

____________________________________________

Respondent's signature

____________________________________________

Printed name

Address:                     ________________________________

                                    ________________________________

                                    ________________________________

Telephone:      ______________________

STATE OF NEW MEXICO              )

                                                            ) ss

COUNTY OF _________________ )

Acknowledged, subscribed and sworn to before me this _____ day of _____________, _____ by _________________, the petitioner.

My commission expires:        ________________________________

_____________________.     Notary Public

USE NOTE

1.         This form should be used by a respondent who has not admitted paternity, but has no objection to an order appointing the petitioners as kinship guardians.

[Provisionally approved, effective August 15, 2003 until August 31, 2004; approved, October 14, 2004.]