700 - 00139E - Consent to Adoption of Adult or Emancipated Minor by Spouse or Partner ( 0 4 /201 7 ) Page 1 of 2 STATE OF VERMONT SUPERIOR COURT PROBATE DIVISION Unit Docket No. In re Adoption of: CONSENT TO ADOPTION OF ADUL T OR E M ANC I P ATE D M I N O R B Y S P O US E OR P ARTNE R 15A V.S A. 2475 - 103 I swear or affirm under oath that the facts set forth below are true and I consent to the adoption of the person named below. My Information : My Name: Date of Birth: Address: Email Address: City/State/Zip: Daytime Phone: Name of Attorney: Address of Attorney: City/State/Zip: Information about the Adult or Emancipated M inor: Name: Date of Birth: Name(s) of the Prospective Adoptive Parents: ( C heck One Box O nly) The prospective adoptive parent and I are married. The date of our marriage is: The prospective adoptive parent and I are partners. We have been partners since: I understand the consequences the adoption m ay ha v e for any ri g ht of inheritance, propert y , or support I ha v e. American LegalNet, Inc. www.FormsWorkFlow.com 700 - 00139E - Consent to Adoption of Adult or Emancipated Minor by Spouse or Partner ( 0 4 /201 7 ) Page 2 of 2 Waiver of Notice: ( C heck One Box O nly) I w ai v e notice to m e of any further proceedin g s in this adoption unless the adoption is con t ested, appealed or denied. I do not w ai v e notice of any further proceedin g s in this adoption. Voluntary Consent: I voluntarily and unequivocally consent to the adoption of this adult or emancipated minor by my spouse or partner. I swear or affirm that the facts set forth in this consent are true and correct to the best of my knowledge and belief. Date At: Signature City, County and State Printed Name Signed and confirmed in the presence of the Judge or in the presence of a person directed by the Judge Date Signature Printed Name of Judge or Other Person Authorized by Judge American LegalNet, Inc. www.FormsWorkFlow.com