North Carolina General Statutes
Article 3 - Adoption of Minors.
§ 48-3-703 - Content of relinquishment; mandatory provisions.

48-3-703. Content of relinquishment; mandatory provisions.
(a) A relinquishment executed by a parent or guardian under G.S. 48-3-701 must be in writing and state the following:
(1) The date and place of the execution of the relinquishment.
(2) The name, date of birth, and permanent address, if any, and if none, the current mailing address, of the individual executing the relinquishment.
(3) The date of birth or the expected delivery date, the sex, and the name of the minor, if known. A relinquishment of a newborn minor may give the minor's name as "Baby [Last Name of Biological Mother]" or similar designation.
(4) The name and address of the agency to which the minor is being relinquished.
(5) That the individual voluntarily consents to the permanent transfer of legal and physical custody of the minor to the agency for the purposes of adoption, and
a. The placement of the minor for adoption with a prospective adoptive parent selected by the agency; or
b. The placement of the minor for adoption with a prospective adoptive parent selected by the agency and agreed upon by the individual executing the relinquishment.
(6) That the individual executing the relinquishment understands that after the relinquishment is signed and acknowledged in the manner provided in G.S. 48-3-702, it may be revoked in accord with G.S. 48-3-706 but that it is otherwise final and irrevocable except under the circumstances set forth in G.S. 48-3-707.
(7) That the relinquishment shall be valid and binding and shall not be affected by any oral or separate written agreement between the individual executing the consent and the agency.
(8) That the individual executing the relinquishment understands that when the adoption is final, all rights and duties of the individual executing the relinquishment with respect to the minor will be extinguished and all other aspects of the legal relationship between the minor child and the parent will be terminated.
(9) That the individual executing the relinquishment has not received or been promised any money or anything of value for the relinquishment of the minor, and has not received or been promised any money or anything of value in relation to the relinquishment or the adoption of the minor except for lawful payments that are itemized on a schedule attached to the relinquishment.
(10) That the individual executing the relinquishment waives notice of any proceeding for adoption.
(11) That the individual executing the relinquishment has provided the agency with the written document required by G.S. 48-3-205, or that the individual has provided the agency with signed releases that will permit the agency to compile the information required by G.S. 48-3-205.
(12) That the individual executing the relinquishment has:
a. Repealed by Session Laws 2013-236, s. 9, effective July 3, 2013.
b. Been advised that counseling services are available through the agency to which the relinquishment is given; and
c. Been advised of the right to seek the advice of legal counsel.
(b) Reserved. (1995, c. 457, s. 2; 2013-236, s. 11; 2015-54, s. 11; 2018-68, s. 2.2; 2019-172, s. 7(d).)