Judicial Consent (Birth Of Legal Parent Private Plaement Step Parent)
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Judicial Consent (Birth Of Legal Parent Private Plaement Step Parent) Form. This is a New York form and can be use in Adoption Statewide.
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Tags: Judicial Consent (Birth Of Legal Parent Private Plaement Step Parent), 2-Fa, New York Statewide, Adoption
D.R.L. §§115, 115-b(8)
Form 2-Fa
(Judicial Consent Birth or Legal ParentPrivate-Placement
Step-parent
8/2002
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.
JUDICIAL CONSENT
(Birth or Legal Parent-Private-Placement Step-parent)
___________________________________
1.
I, [specify name]:
, (birth)(legal) parent of
[specify first name of child]:
of my (daughter)(son), who was born on specify date]:
, adoptive parent.
, residing at
, do hereby consent to the adoption
by [specify name]:
2. The full name and last known address of the other (birth)(legal) parent of the adoptive child
are [optional]:
Dated:
____________________________________________/_________________________
(Birth)(Legal)Parent: typed or printed name/ Signature
______________________________________/________________________________
Attorney if any: typed or printed name/signature
______________________________________________________________________
Attorney’s Address and Telephone number
State of
)
: ss.:
)
County of
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 judicial surrender.
(He)(She) acknowledged to me that (he)(she) executed this surrender.
Judge of the
Court
_____________________
(Seal of Court to be
affixed together
with Court Clerk's
certification)
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