Approved, SCAO FILE NO. STATE OF MICHIGAN 6th JUDICIAL CIRCUIT - FAMILY DIVISION Oakland COUNTY CONSENT TO ADOPTION BY ADOPTEE In the matter of DOB: , adoptee Full name of child 1. I understand that my consent is necessary for this adoption. 2. The judge or referee of the court has fully explained to me that I do not have to sign this consent. 3. I consent to my adoption by and Name Name and I consent to taking the above permanently as my legal parent(s), as though parent(s) by birth. 4. I understand that I shall no longer be an heir of my former parent(s), whose rights have been terminated, except if this is a stepparent adoption, in which case I remain an heir of my biological parent whose rights were terminated and I also become an heir of my adopting parent. 5. I agree that following adoption my name will be . Adoptee Street address City, state, zip The court made such investigation as it deemed necessary and after I fully explained to the adoptee the fact that s/he was consenting to acquire permanently the adopting parents as legal parents as though the adoptee had been born to the adopting parents, and to the termination of right to be an heir at law of his/her former parent(s) whose rights have been terminated.* The adoptee then voluntarily signed this consent before me. A verbatim record of testimony was made. Date Judge/Referee Bar no. *In adult adoptions, see current law in MCL 710.60; MSA 27.3178(555.60) Do not write below this line - For court use only PCA 307 (10/00) CONSENT TO ADOPTION BY ADOPTEE MCL 710.43; MSA 27.3178(555.43), MCR 5.751 American LegalNet, Inc. www.FormsWorkflow.com