____________________ Name ____________________ Address ____________________ City,State,Zip IN THE SUPERIOR COURT OF THE STATE OF CALIFORNIA IN AND FOR THE COUNTY OF EL DORADO In the Matter of the Adoption Petition of: ___________________ (Name) } } } } } STEPPARENT ADOPTION CASE NO: CONSENT OF ADOPTION BY PARENT RETAINING CUSTODY Name of Minor I, the undersigned, being the father/mother of _____________ give my full and free consent to the adoption of said child by , who is my husband/wife without Husband/Wife name relinquishing any of my rights, duties, obligations as his/her father/mother and I respectfully ask that the petition be granted. Said child was born on Birth Date , in City and State and is the child of Name of Legal Father and Name of Legal Mother . DATED: ____________________ ____________________________ Signature of Parent Signed in the presence of *Title The Judge/Commissioner of the Superior Court or the Clerk of the Superior Court may witness. NOTARY SEAL OR SIGN IN COURT Local Form A-2 Rev. 3/4/02 American LegalNet, Inc. www.FormsWorkflow.com