THE STATE OF FLORIDA REQUIRES, PURSUANT TO CHAPTER 63 OF THE FLORIDA STATUTES, THAT THIS FORM BE PROVIDED TO ALL PERSONS CONSIDERING ADOPTING A MINOR OR SEEKING TO PLACE A MINOR FOR ADOPTION, TO ADVISE THEM OF THE FOLLOWING FACTS REGARDING ADOPTION UNDER FLORIDA LAW:

1. The name, address and telephone number of the adoption entity providing this disclosure is: JEANNE T. TATE, P.A. 418 WEST PLATT STREET, SUITE B, TAMPA, FL, 33606 813-258-3355

2. The adoption entity does not provide legal representation or advice to birth parents, and birth parents have the right to consult with an attorney of their own choosing to advise them.

THIS MEANS THAT THE ADOPTION ENTITY'S ATTORNEYS, JEANNE T. TATE, DANELLE D. BARKSDALE, MARTHA A. CURTIS AND STEVEN HURWITZ, DO NOT AND CANNOT REPRESENT THE BIRTH PARENTS. THE ADOPTION ENTITY'S FEES AND ATTORNEY FEES ARE PAID FOR BY THE PROSPECTIVE ADOPTIVE PARENTS.

3. With the exception of an adoption by a stepparent or relative, a minor child cannot be placed into a prospective adoptive home unless the prospective adoptive parents have received a favorable preliminary home study, including criminal and child abuse clearances.

4. A valid consent for adoption may not be signed by the birth mother until 48 hours after the birth of the child or the day the birth mother is notified, in writing, that she is fit for discharge from the licensed hospital or birth center. A putative father may sign a valid consent for adoption at any time after the birth of the child.

5. A consent for adoption signed before the child attains the age of 6 months is binding and irrevocable from the moment it is signed unless it can be proven in court that the consent was obtained by fraud or duress. A consent for adoption signed after the child attains the age of 6 months is valid from the moment it is signed; however, it may be revoked until the child is placed in an adoptive home, or up to 3 days after it was signed, whichever period is longer.

6. A consent for adoption is not valid if the signature of the person who signed the consent was obtained by fraud or duress.

7. There are alternatives to adoption, including foster care, relative care, and parenting the child. There may be services and sources of financial assistance in the community available to birth parents if they choose to parent the child.

8. A birth parent has the right to have a witness of his or her choice, who is unconnected with the adoption entity or the adoptive parents, to be present and witness the signing of the consent or affidavit of nonpaternity.

9. A birth parent 14 years of age or younger must have a parent, legal guardian, or court-appointed guardian ad litem to assist and advise the birth parent as to the adoption plan.

10. A birth parent has a right to receive supportive counseling from a counselor, social worker, physician, clergy, or attorney, and such counseling would be beneficial to the birth parent.

11. The payment of living or medical expenses by the prospective adoptive parents prior to the birth of the child in no way obligates the birth parent to sign the consent for adoption. Acknowledgment of

Acknowledgment of Disclosure:

Signature:_______________________

Print name:______________________

Date:___________________________

Time:___________________________

Sign here to acknowledge that a copy of this disclosure was received for your records:

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