J DF 511 R 1 /1 8 CONS ENT TO ADOPTION CHILD OVER 12 YEARS OF AGE 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 COUR T USE ONLY Attorney or Party Without Attorney (Name and Address): Phone Number: E - mail: FAX Number: Atty. Reg. #: Case Number: Division Courtroom CONSENT TO ADOPTI ON CHILD OVER 12 YEARS OF AGE 1. I hereby consent to my adoption by (name of party) and waive any and all notices required by law. 2. I am years of age and my date of birth is . I, , swear/affirm under oath that I have read the foregoing Consent to Adoption Child Over 12 Years of Age and that the statements set forth herein are true to the best of my knowledge and belief. By checking thi s 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. SIGNATURE Printed name of Adoptee Signature of Adoptee Date American LegalNet, Inc. www.FormsWorkFlow.com