IN THE INTEREST OF IN THE DISTRICT COURT OF
(CHILD'S NAME HERE) (COUNTY, AND STATE HERE}
MINOR CHILD (COURT NAME)
REVOCATION OF AFFIDAVIT OF RELINQUISHMENT OF PARENTAL RIGHTS:
Comes now, (your name), and revokes the previously signed
affidavit of relinquishment of parental rights that was signed on the
(Day...example...24th) day of (Month), in the year of our Lord
(Year...example...2002).
Respectfully Submitted
(Your name) (Your Title In The Case...Respondent Mother or Father) (Your
Adress) (Your Address Continued) (City and State) (Your Current Phone
Number)
