STATE OF CALIFORNIA—HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES Original for Court Record IN THE SUPERIOR COURT OF THE STATE OF CALIFORNIA IN AND FOR THE COUNTY OF_____________________ In the Matter of the Petition of } _________________________________ STEPPARENT ADOPTION Consent to Adoption by Parent in California Giving Custody to Husband or Wife or Domestic Partner of Other Parent Petitioner I, the undersigned, being the parent of__________________________________________________________ Name of Child do hereby give my full and free consent to the adoption of said child by _____________________________________________________________________________________________ , Name of Petitioner (Stepparent) the petitioner herein, it being fully understood by me that with the signing of this document my consent may not be withdrawn except with court approval, and that with the signing of the order of adoption by the court, I shall give up all my rights of custody, services, and earnings of said child, and that said child cannot be reclaimed by me. Said child was born on ____________________________________ in _____________________________________________ Date City and State and is the child of ____________________________________________and _____________________________________________ Name of Birth Parent Name of Birth Parent DATE_________________________ 20_____ ____________________________________________ Signature of Parent Signed in the presence of ___________________________________________________________________ *Title *The Clerk of the Superior Court, the Probation Officer, or, where stepparent investigations are delegated to County Welfare Departments, a County Welfare Department Staff member may witness. NOTICE TO THE BIRTH PARENT WHO CONSENTS TO THE CHILD’S ADOPTION: If you or your child lived together at any time as parent and child, the adoption of your child by a stepparent does not affect the child’s right to inherit your property or the property of blood relatives. For further information regarding this right of inheritance, you should consult an attorney at your own expense. This form to be used only when parent is giving custody of the child to the husband or wife or domestic partner, as defined in Family Code Section 297, of other parent. Original for court record. AD 2A (6/02) American LegalNet, Inc. www.USCourtForms.com