Indiana Code Title 31. Family Law and Juvenile Law § 31-19-4.5-3

Sec. 3. Notice of the adoption proceeding shall be given to a person entitled to notice under section 2 of this chapter in substantially the following form:

“NOTICE OF ADOPTION

________ (person's name) is notified that a petition for adoption of a child, named __________ (child's name, if named), born to __________ (mother's name) on __________ (date) was filed in the office of the clerk of __________ court, __________ (address of the court).  The petition for adoption alleges that the consent to adoption of __________ (person's name) is not required because _________________________ (provide a brief description of the reason(s) the consent is not required).

If __________ (person's name) seeks to contest the adoption of the child, __________ (person's name) must file a motion to contest the adoption in accordance with IC 31-19-10-1 in the above named court not later than fifteen (15) days after the date of service of this notice.

If __________ (person's name) does not file a motion to contest the adoption within fifteen (15) days after service of this notice the above named court will hear and determine the petition for adoption.  The consent to adoption of __________ (person's name) will be irrevocably implied and __________ (person's name) will lose the right to contest either the adoption or the validity of __________'s (person's name) implied consent to the adoption.

No statement made to __________ (person's name) relieves __________(person's name) of __________'s (person's name) obligations under this notice.

This notice complies with IC 31-19-4.5-3 but does not exhaustively set forth a person's legal obligations under the Indiana adoption statutes.  A person being served with this notice should consult the Indiana adoption statutes.”.