Nevada Revised Statutes Title 11. Domestic Relations § 127.055. Consent to adoption: Attesting witnesses may make self-proving affidavits to be attached to consent

1. Any or all of the attesting witnesses to any consent to adoption may, at the request of the person or persons who executed the consent, 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 consent to adoption. The affidavit must be written on the 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 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:

Then and there personally appeared the within-named ________________ and ________________, who, being duly sworn, depose and say: That they witnessed the execution of the within consent to adoption by ________________ (name of person or persons consenting); that she, he or they subscribed the consent to adoption and declared the same to be a voluntary consent to adoption in their presence; that at the time the consent to adoption was executed it contained the names of the person or persons to whom 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 consenting) and in the presence of each other and at the request of ________________ (name of person or persons consenting); that at the time of the execution of the consent to adoption ________________ (name of person or persons consenting) acknowledged to them that she, he or they was or were, and she, he or they appeared to them to be, in full possession of her, his or their faculties and not under the influence of any drug or sedative or subject to any duress, fear, menace, compulsion or undue influence whatever; and that they make this affidavit at her, his or their request.

Subscribed and sworn to before me this ________ day of the month of ________ of the year ________