RELINQUISHMENT AGREEMENT

 

 

The ______________________________________________ (Agency Name) hereby states its willingness to accept the attached relinquishment agreement as written and to undertake custody of the child named in the agreement for the sole purpose of placing said child in a suitable adoptive home.

 

 

I hereby execute this relinquishment agreement as the duly authorized representative of _________________________________ (Agency) at ___________________________ (Place of Execution) on _____________ (Date).

 

 

 

_________________________________________                            _________________

Signature of Authorized Official of Agency                                                Date