NRS 127D.170: Affidavit of attesting witnesses as proof of due execution of specific consent to adoption.

1. Any or all of the attesting witnesses to any specific consent to adoption may make and sign an affidavit before any person authorized to administer oaths in this State, stating such facts as they would be required to testify to in court to prove the due execution of the specific consent to adoption. The affidavit must be written on the specific consent to adoption or, if that is impracticable, on some paper attached thereto. The sworn statement of any witness so taken must be accepted by the court in any action or proceeding relating to the validity or due execution of the specific consent to adoption as if it had been taken before the court.

2. The affidavit described in subsection 1 may be substantially in the following form:

State of Nevada }

}ss.

County of................................... }

(Date)..............................................

Then and there personally appeared the within-named ................ and ................, who, being duly sworn, depose and say: That they witnessed the execution of the within specific consent to adoption by ................ (name of person or persons giving consent); that they subscribed the specific consent to adoption and declared the same to be a voluntary specific consent to adoption in their presence; that at the time the specific consent to adoption was executed it contained the name of the person or persons to whom specific consent was thereby given to adopt the child; that they thereafter subscribed the same as witnesses in the presence of ................ (name of person or persons giving consent) and in the presence of each other and at the request of ................ (name of person or persons giving consent) that at the time of the execution of the consent to adoption ................ (name of person or persons giving consent) acknowledged to them that they were, and they appeared to them to be, in full possession of their faculties and not under the influence of any drug or sedative that could impact their reasoning or judgment or subject to any duress, fear, menace, compulsion or undue influence whatever; and that they make this affidavit at their request.

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Subscribed and sworn to before me

this ...... day of the month of ...... of the year ......

Notary Public