FORM 19.11C Notice to Putative Father of Hearing on Petition for Voluntary Relinquishment

IN THE COURT OF COMMON PLEAS OF

__________________ COUNTY, PENNSYLVANIA

IN RE: : No.

ADOPTION OF

NOTICE

To

(Putative Father's Name)

A Petition has been filed asking the Court to put an end to all rights you have to your child

. The Court has set a hearing to consider ending your rights to your child.

That hearing will be held at , County Courthouse,

Room number , , , on the day of ,

20 , at o'clock [am/pm]

Your presence is required at the hearing. Your parental rights may be subject to termination

pursuant to 23 Pa. C.S. § 2503(d) if you fail to file an acknowledgment of paternity or claim

of paternity pursuant to 23 Pa. C.S. § 5103, and you fail either to appear at the hearing for the

purpose of objecting to the termination of your rights or to file a written objection to the

termination of your rights with the Court prior to the hearing.

YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW. THIS OFFICE CAN PROVIDE YOU WITH INFORMATION ABOUT HIRING A LAWYER. IF YOU CANNOT AFFORD A LAWYER, THIS OFFICE MAY BE ABLE TO PROVIDE YOU WITH INFORMATION ABOUT AGENCIES THAT MAY OFFER LEGAL SERVICES TO ELIGIBLE PERSONS AT A REDUCED FEE OR NO FEE.

LANCASTER BAR ASSOCIATION

LAWYER REFERRAL SERVICE

28 EAST ORANGE STREET

LANCASTER, PA. 17602

TELEPHONE: (717)393-0737