Withdrawal of surrender instructions

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FORM 581

Form 581 may be used when the parent, guardian or biological father who is not also the legal father has voluntarily surrendered his/her child for adoption to DHR and decides within the ten (10) day limitation to revoke his/her surrender. Form 581 must be completed for each Form 572, Form 573, or Form 580 that the parent, guardian, or biological father who is not also the legal father wishes to revoke.

Each of three (3) copies of Form 581 must contain original signatures and raised notary seal. One copy is to be kept with the original material on the child, the second copy is for the county file and the third copy is for the signer.
All dates on the Form 581 must be the same as they appear on the Form 572, Form 573, or Form 580 and that the Form 581 is signed within the ten (10) day revocation period. The name and birth date of the child and the signature of the signer must be the same as on the previously signed surrender documents. The notary may not be the caseworker who has worked with the family.
A person who wishes to withdraw their voluntary surrender is not required to use the Form 581, however, if they come to the county department to indicate that they wish to withdraw their surrender, the Form 581 is appropriate to use.

Form 581I Withdrawal of Surrender – Instructions Page 1 of 1

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