19th Cir. — judge-katherine-mish__AFFIDAVIT-AND-ACKNOWLEDGEMENT-OF-SURRENDER-CONSENT-1.pdf: published requirements · BenchPath

Florida›Nineteenth Judicial Circuit›St. Lucie County

19th Cir. — judge-katherine-mish__AFFIDAVIT-AND-ACKNOWLEDGEMENT-OF-SURRENDER-CONSENT-1.pdf: published requirements

High confidence· verified July 24, 2026Special Set Hearings19th Jud. Cir., judge-katherine-mish__AFFIDAVIT-AND-ACKNOWLEDGEMENT-OF-SURRENDER-CONSENT-1.pdf (pp. 1) — sha256-hashed 2026-07-24

Summary

1 verbatim requirement extracted from judge-katherine-mish__AFFIDAVIT-AND-ACKNOWLEDGEMENT-OF-SURRENDER-CONSENT-1.pdf, across 1 topic.

Applies to

Nineteenth Judicial Circuit (Indian River, Martin, Okeechobee, St. Lucie). Check the order's own effective and rescission dates before relying on it. Procedural information only; not legal advice.

Requirement

Verbatim from the order, captured 2026-07-24; whitespace normalised only. No OCR was used anywhere in this chain. HEARING TIME & ARGUMENT LIMITS • AF FIDAVIT AND ACKNOWLEDGEMENT OF SURRENDER, CONSENT AND WAIVER OF NOTICE Page 1 of 2 IN THE CIRCUIT COURT OF THE NINETEENTH JUDICIAL CIRCUIT IN AND FOR ST. LUCIE COUNTY, FLORIDA I N THE INTEREST OF: CASE NO.: 5620____DP 000________ _________ ________________________________, DOB: ______________, A Minor Child. _____________________________________________/ AFFIDAVIT AND ACKNOWLEDGEMENT OF SURRENDER, CONSENT AND WAIVER OF NOTICE I , ___________________________, being duly sworn, testify and say: 1. I a m the mother/ father of ______________________________________, a female/ male child born on ___________________________, in ____________________ County, Florida; 2. I believe it is in the best interest of this child to release this child to the Department of Children and Families to be adopted. 3. I surrender this child to the Department of Children and Families, an agency willing to take this child and place this child for adoption. 4. B y this surrender I give up my rights to receive notice of any and all future hearings and proceedings regarding this child, including legal adoptions hearings. 5. I HEREBY CONSENT PERMANENTLY, COMPLETELY AND FINALLY TO: a. T he permanent commitment of this child to the Department of Children and Families for subsequent adoption. b. The permanent deprivation of my present parental rights to this child. 6. I hereby give up all rights to future information concerning the whereabouts of this child, or the identity or location of any adoptive parent of this child, and I give up my right to have any court compel the Department of Children and Families, or any of its authorized agents, to give me any such information. 7. I HEREBY ACKNOWLEDGE that I have read this form concerning thi s chil d, _________ __________________________________ and I clearly understand its meaning and it is correct and true to the best of my knowledge and belief, and I have freely and voluntarily signed this Affidavit and Acknowledgment of Surrender, Consent and Waiver of Notice in order to release this child for adoption. 8. I was informed of my right to an attorney in the proceeding to terminate parental rights, including the right of an indigent person to be represented by court appointed counsel, and I have, in fact, been represented by counsel through the proceedings and for the purpose of signing this affidavit.

Source of truth

AF FIDAVIT AND ACKNOWLEDGEMENT OF SURRENDER, CONSENT AND WAIVER OF NOTICE Page 1 of 2 IN THE CIRCUIT COURT OF THE NINETEENTH JUDICIAL CIRCUIT IN AND FOR ST. LUCIE COUNTY, FLORIDA I N THE INTEREST OF: CASE NO.: 5620____DP 000________ _________ ________________________________, DOB: ______________, A Minor Child. _____________________________________________/ AFFIDAVIT AND ACKNOWLEDGEMENT OF SURRENDER, CONSENT AND WAIVER OF NOTICE I , ___________________________, being duly sworn, testify and say: 1. I a m the mother/ father of ______________________________________, a female/ male child born on ___________________________, in ____________________ County, Florida; 2. I believe it is in the best interest of this child to release this child to the Department of Children and Families to be adopted. 3. I surrender this child to the Department of Children and Families, an agency willing to

Official source: 19th Circuit — Administrative Orders (circuit19.org)
Source health: Healthy · checked July 24, 2026
Effective date: —
Last verified: July 24, 2026benchpath-completeness-2026-07-24

Reviewer note: Document sha256: e048d11b13a31b59764e128c4509803d5d154e8da34a3b3e6796f4ecea1ebeb6. One rule per order rather than per topic, so an order's requirements stay together. Published during the completeness pass.