Adoption Agreement PC-681 REV. 4/19 CONNECTICUT PROBATE COURTS CONFIDENTIAL Adoption Agreement RECEIVED: Instructions: 1) A person authorized to give a minor in adoption under C.G.S. section 45a-724 may enter into an adoption agreement with the adopting parent or parents if the minor is free for adoption. 2)Both the person giving the minor in adoption and the adopting parent or parents must sign theadoption agreement. 3)This adoption agreement should be filed in duplicate along with Form PC-601, Petition/ConsentTermination of Parental Rights and Stepparent, Co-Parent or Relative Adoption, or PC-603, Petition/Adoption. 4)For more information, see C.G.S. sections 45a-724, 45a-725 and 45a-727. 5) Type or pri nt the form in ink. Use a separate sheet, or PC - 180, Second Sheet, if more space is needed. Probate Court Name District Number In the Matter of (First name only) Hereinafter referred to as the minor Minor222s Date of Birth Pers on Giving Minor in Adoption under C.G.S. section 45a - 724 ( Check only one.): Parent of the minor (Name): Guardian of the person of the minor (Name): Statutory parent (Name and address of local office): Adopting Parent(s) (Name and address) The person giving the minor in adoption represents that the person is the: (Check only one.) Parent of the minor Guardian of the person of the minor Statutory parent and is authorized to give the minor in adoption under C.G.S. section 45a-724. The person giving the minor in adoption and the adopting parent or parents each represent that they are lawfully entitled to enter into this Adoption Agreement. The person giving the minor in adoption does hereby give the minor named above in adoption to the adopting parent or parents and the adopting parent or parents do hereby adopt and receive the minor as their legal child. PC-8 American LegalNet, Inc. www.FormsWorkFlow.com Adoption Agreement PC-681 REV. 4/19 CONNECTICUT PROBATE COURTS CONFIDENTIAL Adoption Agreement The parties also agree that The parent of the minor giving the minor in adoption in no way relinquishes any parental right in and to the minor. The name of the minor shall be changed to: The parties agree that this Adoption Agreement shall take effect upon its approval by the Probate Court. Parent or Guardian Giving Minor in Adoption: Signature Type or Print Name Date Statutory Parent: Name of Statutory Parent Signature Type or Print Name Title Date Adopting Parent(s): Signature Type or Print Name Date Signature Type or Print Name Date Consent of Minor I, the undersigned minor, being at least 12 years of age, consent to this Adoption Agreement. C.G.S. section 45a-724(b). Signature Date Type or Print Name In the Matter of (First name only) PC-8 American LegalNet, Inc. www.FormsWorkFlow.com