Affidavit And Consent Of Person Having Lawful Custody (Other Than Birth Or Legal Parent- Private Placement)
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Affidavit And Consent Of Person Having Lawful Custody (Other Than Birth Or Legal Parent- Private Placement) Form. This is a New York form and can be use in Adoption Statewide.
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Tags: Affidavit And Consent Of Person Having Lawful Custody (Other Than Birth Or Legal Parent- Private Placement), 2-E, New York Statewide, Adoption
D.R.L. §§ 109(6), 111(1)(f),
115(6)
Form 2-E
(Affidavit and Consent
- Person Having Custody
Private-Placement)
8/2002
FAMILY COURT OF THE STATE OF NEW YORK
COUNTY OF
____________________________________
In the Matter of the Adoption of
A Child whose First Name is
(Docket)(File) No.
AFFIDAVIT AND
CONSENT
OF PERSON HAVING
LAWFUL CUSTODY
(Other than Birth
or Legal ParentPrivate-Placement)
_____________________________________
STATE OF NEW YORK
COUNTY OF
)
ss.:
)
(I) (we) [specify name(s)]:
(and
being duly sworn, depose(s) and say(s):
),
Deponent(s) reside(s) at
and (is)(are) the person(s) having lawful custody of the above-named adoptive child in that:
[recite facts showing how lawful custody was obtained]
(and
Deponent(s) hereby consent(s) to said child's adoption by the petitioning adoptive parent(s)
).
________________________________
________________________________
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Form 2-E page 2
______________________________________/______________________________
Affiant (Person Having Legal Custody) typed or printed name/ signature
______________________________________/________________________________
Attorney if any: typed or printed name/signature
______________________________________________________________________
Attorney’s Address and Telephone number
STATE OF NEW YORK
COUNTY OF
)
ss.:
)
On [specify date]:
, [specify name]:
personally appeared before me. (He)(She) is personally known to me or proved (his)(her) identity to
me by satisfactory evidence as the person whose name is subscribed on this affidavit and consent.
(He)(She) acknowledged to me that (he)(she) executed this affidavit and consent.
_______________________________
Notary Public
STATE OF NEW YORK
COUNTY OF
)
ss.:
)
On [specify date]:
, [specify name]:
personally appeared before me. (He)(She) is personally known to me or proved (his)(her) identity to
me by satisfactory evidence as the person whose name is subscribed on this affidavit and consent.
(He)(She) acknowledged to me that (he)(she) executed this affidavit and consent.
_______________________________
Notary Public
American LegalNet, Inc.
www.FormsWorkFlow.com
