COURT COUNTY OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .:::::::Index No.Calendar No.SUPERIOR COURT OF THE DISTRICT OF COLUMBIA FAMILY COURT DOMESTIC RELATIONS BRANCH ADOPTIONJUDICIAL SUBPOENAPlaintiff(s) -against-Defendant(s)EX PARTE IN THE MATTER OF)CASE NO: ) THE PETITION OF) ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .)JUDGE RONNA LEE BECK ) FOR ADOPTION OF MINOR CHILD)THE PEOPLE OF THE STATE OF NEW YORK TOCONSENT OF ADOPTEEI,have read the petition ofGREETINGS:for my adoption, and do consent that the petitionWE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Court at the the Honorablebe granted. My consent to be adopted and any request that my name be changed is not for the purpose of evading any creditors of for any other illegal or immoral purposes. I also waive service of process or notice of any kind upon me in this action.,located at County ofo'clock in the day of, on the, 20, at or adjourned date, to testify and give evidence as a witness in this action on the part of thenoon, and at any recessed in roomYour failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply. DateSignature of Adoptee, one of the Justices of the, being first sworn under oath, states that he/she has read the Consent and believes that the statements made therein are true to the best of his/her knowledge and belief.Court in Witness, Honorableday of, 20 County,(Attorney must sign above and type name below) DateAssociate Judge/Deputy Clerk/Notary PublicAttorney(s) forSubscribed and sworn to before me on .Office and P.O. AddressDeputy Clerk/Notary PublicTelephone No.: Facsimile No.: E-Mail Address:Mobile Tel. No.:American LegalNet, Inc. www.USCourtForms.com