COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Probate .Court Form No. 139h .... .. .. : Consent of Partner (Page 1 of 2) Index No. STATE OF VERMONT DISTRICT OF _______________________ Plaintiff(s) : Calendar No. PROBATE COURT -againstIN RE ADOPTION OF ______________________ : DOCKET NO. _________________ : JUDICIAL SUBPOENA : CONSENT OF PARTNER 15A V. S. A. 4-104 : 1. My Full Name ___________________________________ Defendant(s) : ...................................................... 2. My Mailing Address ______________________________ ______________________________ ______________________________ THE PEOPLE OF THE STATE OF NEW YORK TO 3. My Date of Birth __________________________________ 4. Full Name of Minor Who Is Being Adopted __________________________________ 5. Date of Birth of Minor Who Is Being Adopted ________________________________ GREETINGS: 6. Full Name, Address and Telephone Number of the Attorney Representing the Prospective WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Adoptive Parent(s) With Whom I have Placed, or Intend to Place My Minor Child for , the Honorable at the Court Adoption: located at County of _______________________________________ in room , on the day of , 20 , at o'clock in the noon, and at any recessed _______________________________________ or adjourned date, to testify and give evidence as a witness in this action on the part of the _______________________________________ 7. I state that I have legal and physical custody of my above-named minor child. I voluntarily and unequivocally comply with adoption of my said minor as a contempt of court and will make you liable to Your failure to consent to thethis subpoena is punishable child. the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a 8. understand and agree that the adoption will not terminate the relationship between my minor result of yourI failure to comply. child and me. Witness, Honorable , one of the Justices of the 9. I understand and agree that the adoption will terminate the relationship of parent and child Court in County, day of , 20 between my minor child and the minor child’s other parent. 10. I understand and agree that the adoption will terminate any existing court order for custody, visitation, or communication with the minor child. (Attorney must sign above and type name below) 11. I understand and agree that notwithstanding the adoption: Attorney(s) for A. the minor and any descendant of the minor will retain rights of inheritance from and through the minor’s other parent; B. a court order for visitation or communication with the minor by me, or by a person Office and P.O. Address related to the minor through me, or an agreement or order concerning another person which is approved by the court under 15A V. S. A. 4-112, survives the decree of adoption, but failure to comply with the terms of the order or agreement is not a ground for revoking or setting aside this consent or the adoption; Telephone No.: Facsimile No.: C. the other parent remains liable for arrearage child support unless relieved of that E-Mail Address: obligation by me, and any guardian ad litem of the minor and by the governmental agency Mobile Tel. No.: providing public assistance to the minor. American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Probate .Court Form 139h .... .. .. : Consent of Partner (Page 2 of 2) Index No. : Calendar No. 12. This consent is not, and cannot be, a waiver of any further notice to me of the proceeding for : adoption of the minor child by the person seeking to adopt. JUDICIAL SUBPOENA Plaintiff(s) -against: 13. I swear that the factual information set forth in this consent is true and correct to the best of my knowledge and belief. : Dated: __________________________ Signed _____________________________ : Defendant(s)Print Name: _________________________ : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Address: ____________________________ ....... ____________________________________ Telephone: (____) ____________________ THE PEOPLE OF THE STATE OF NEW YORK STATE OF VERMONT COUNTY OF _______________________ TO On the _____ day of ____________________ 20___, ___________________________________ GREETINGS: personally appeared before me and signed or confirmed in my presence that he or she freely and voluntarily signed the above consent and acknowledged that the factual information set forth therein is true and correct WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before to the best of his or her knowledge and belief. , the Honorable at the Court located at County ofI am one of the following: in room , on the day of , 20 , at o'clock in the noon, and at any recessed or adjourned date, Judge of a court that has jurisdiction overin this action on the part of the to testify and give evidence as a witness adoption proceedings in the State of Vermont; _____ a _____ a person appointed by a Probate Judge to take consents or relinquishments; Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to _____ a commissioned officer on active duty in the military service of the United States and the the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a person signing the consent is in the military service; result of your failure to comply. _____ an officer of the foreign service or a consular officer of the United States in another country, Witness, Honorable , one of this consent appeared to wit: _________________________________, and the person executingthe Justices of the Court in before me inCounty, , 20 that country; day of _____ a person authorized to take acknowledgments. (Attorney must sign above and type name below) _____________________________ (Signature) Attorney(s) for _____________________________ (Printed Name) Office and P.O. Address Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com