IN THE SUPERIOR COURT FOR THE STATE OF ALASKA AT In the matter of the adoption of ) ) ) ) ) ) ) ) ) CASE NO. ) ) CONSENT TO STEPPARENT ADOPTION (FROM PETITIONER'S SPOUSE) , am the biological (name) of (child's current full name) 2. I understand that prior to signing this consent I have the right to consult with an attorney of my choice, at my expense. I consent to the adoption of the above-named child by my husband wife, who is the petitioner named above. I do not, however, give up any of my rights, duties or obligations as the child's legal parent. I understand I have a limited right to withdraw my consent. I understand that my consent cannot be withdrawn after the judge signs the decree of adoption. However, before the adoption decree is signed, I can withdraw my consent as follows: a. Within 10 days after I sign this form, I can deliver written notice to the court at the address in paragraph 5 or to the person who obtained my consent. This written notice must be delivered or postmarked by the tenth day. After the above 10-day period, if the decree has not been signed, I can file a request to withdraw with the court, which the court may or may not grant. My request will be granted only if the court finds that it is in the best interests of the child after both the petitioner and I are given notice and an opportunity to be heard. . mother father , (child's name after adoption) DOB: , A Minor Child, By , Petitioner. 1. I, 3. 4. b. 5. I understand that the adoption petition will be filed in the Superior Court at: Court Address: Court Telephone Number: American LegalNet, Inc. www.FormsWorkFlow.com Page 1 of 2 P-410 (5/12)(cs) CONSENT TO STEPPARENT ADOPTION (FROM PETITIONER'S SPOUSE) AS 25.23.060-.070 Adoption Rule 9 6. The child is not a member of an Indian tribe or an Alaska Native Village. In addition, the child is not eligible for such membership, and neither of the child's biological parents is a member of an Indian tribe or an Alaska Native Village. This consent is effective as a power of attorney under AS 13.26.020, delegating to petitioner parental authority over the care, custody and property of the minor child during the pendency of the adoption proceeding. However, I understand that this delegation does not affect my own parental rights, duties or obligations toward the child. I am am not a minor. My date of birth is . 7. 8. 9. I acknowledge that I have received a copy of this consent (or will receive one after it is signed). Verification I state on oath or affirm that I have read this consent form and believe all statements made in it are true. Date Signature of Parent Giving Consent Mailing Address City State Daytime Phone ACKNOWLEDGEMENT & OATH , personally appeared (date) (name) before me in , Alaska, signed the above consent to adoption, certified under oath or affirmation that he/she has read it and believes its contents to be true, and acknowledged that he/she signed the consent freely and voluntarily for the purposes stated therein. (SEAL) Clerk of Court, Notary Public or other person authorized to administer oaths. My commission expires: American LegalNet, Inc. www.FormsWorkFlow.com Zip On Page 2 of 2 P-410 (5/12)(cs) CONSENT TO STEPPARENT ADOPTION (FROM PETITIONER'S SPOUSE) AS 25.23.060-.070 Adoption Rule 9