JDF 509 R1/18 CONSENT TO ADOPTION 226 CUSTODIAL PARENT District Court Denver Juvenile Court County, Colorado Court Address: IN THE MATTER OF THE PETITION OF: (name of person(s) seeking to adopt) FOR THE ADOPTION OF A CHILD COURT USE ONLY Attorney or Party Without Attorney (Name and Address): Phone Number: E-mail: FAX Number: Atty. Reg. #: Case Number: Division Courtroom CONSENT TO ADOPTION 226 CUSTODIAL PARENT 1. I certify that I am the birth father mother of (name of child) and I certify that the Respondent is the birth father mother of said child. 2. I certify that I am consenting to the adoption of the child by the above-named Petitioner(s). By checking this box, I am acknowledging I am filling in the blanks and not changing anything else on the form. By checking this box, I am acknowledging that I have made a change to the original content of this form. VERIFICATION I declare under penalty of perjury under the law of Colorado that the foregoing is true and correct. Executed on the day of , , at (date) (month) (year) (city or other location, and state OR country (printed name of Father/Mother Signature of Father/Mother American LegalNet, Inc. www.FormsWorkFlow.com