FORM SUMMARY Name of Form: Consent to Adoption Form Number: JC-1646 Statutory Reference: Chapters 48 and 882, Wisconsin Statutes. Purpose of Form: Form signed by child over 14 and an adult consenting to the adoption. Who Completes It: Party seeking adoption. Distribution of Form: Original to court Accompanying Forms: Generally none New Form/Modification: Modification, last update 7/96. Modifications: Added a file/date stamp area to upper right corner. Added a statement on the bottom indicating that the form shall not be modified. Comments: None About this form: This form is the product of the Wisconsin Records Management Committee, a committee of the Director of State Court's Office and a mandate of the Wisconsin Judicial Conference. If you have additional information that does not change the meaning of the form, attach it on a separate page. The form itself shall not be altered. Date: 05/31/00 Page 1 2001 © American LegalNet, Inc. For Official Use STATE OF WISCONSIN, CIRCUIT COURT, COUNTY Consent to Adoption IN THE MATTER OF THE ADOPTION OF Name Case No. Date of Birth Under oath, I consent to this adoption. Subscribed and sworn to before me on Signature Name Printed or Typed Notary Public, State of Wisconsin Date My commission expires: JC-1646, 05/00 Consent to Adoption Chapters 48 and 882, Wisconsin Statutes. This form shall not be modified. It may be supplemented with additional material. Page 1 of 1 2001 © American LegalNet, Inc.