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: } STEPPARENT ADOPTION CASE NO: CONSENT OF ADOPTION BY PARENT OUTSIDE CALIFORNIA GIVING CUSTODY TO HUSBAND OR WIFE OF OTHER PARENT do hereby give my full Name of Minor ___________________ (Petitioner) } } } } } I, the undersigned, being the father/mother of 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the petitioner herein, it being fully understood by me that with the signing of this document my consent may not be withdrawn except with court approval, and that with the signing of the order of adoption by the court, I shall give up all my rights of custody, services, and earning of said child, and that said child cannot be reclaimed by me. Said child was born on Birth Date , in City and State and is the child of Name of Natural Father and Name of Natural Mother Signature of Parent Date ________________ 20 STATE OF County of Before me, personally appeared } } } ss. , a Notary Public in and for said County and State, , known to me to be the person whose name is subscribed to the within instrument, and acknowledged to me that he/she executed the same. IN WITNESS WHEREOF, I have hereunto set my hand and affixed my official seal this , 20 . Notary Public in and for said County and State NOTICE TO 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 is to be used only when parent is giving custody of the child to the husband or wife of other parent. Original for court record. day of Local Form A-5 12/1/04 American LegalNet, Inc. www.FormsWorkflow.com