CHAPTER 8. STATEMENT OF FAMILY HISTORY; FORM

Art. 1124. Requirement of family information

A. A surrendering parent shall execute a Statement of Family History which shall be attached to the Act of Surrender, shall be included in the sealed adoption record, and shall be given to the prospective adoptive parents at the time of placement and made available, upon request, to the adopted person at the age of eighteen years or older.

B. A surrendering parent shall execute an affidavit attesting to the parent's execution of the Statement of Family History which shall be included in the sealed adoption record only and shall not be given to the prospective adoptive parents or the adopted person.

C. The form for the affidavit shall be substantially as follows:

STATE OF _____________________

PARISH/COUNTY OF ______________________________

AFFIDAVIT

BEFORE ME, the undersigned authority, personally came and appeared

_______________________________________

SURRENDERING PARENT

who declares that he/she has executed a true and correct Statement of Family History to provide the adoptive parents of the minor child with nonidentifying medical genetic information in accordance with the provisions of Louisiana Children's Code Articles 1124 through 1127.

Affiant understands and agrees that the nonidentifying Statement of Family History will be attached to the Act of Surrender and included in the sealed adoption record. Affiant further understands that the Statement of Family History will be given to the prospective adoptive parent(s) at the time of placement and made available, upon request, to the adopted person at the age of eighteen years or older.

Affiant has been informed that this affidavit shall be included in the sealed adoption record only and will not be given to the adoptive parents or the minor child.

_______________________________________

SIGNATURE OF SURRENDERING PARENT

_______________________________________

NAME OF SURRENDERING PARENT

SWORN TO AND SUBSCRIBED BEFORE ME THIS ______ DAY OF

____________, 20____.

____________________________

NOTARY PUBLIC

Acts 1991, No. 235, §11, eff. Jan. 1, 1992; Acts 1992, No. 705, §5, eff. July 6, 1992; Acts 1993, No. 634, §1, eff. June 15, 1993; Acts 2001, No. 910, §1; Acts 2008, No. 583, §1.