Consent Of Guardian Or Agency In Stepparent Adoption {139B}

700 - 00139B - Consent of Guardian or Agency to Adoption (Stepparent or Partner Adoption) (0 4/2017 ) Page 1 of 2 STATE OF VERMONT SUPERIOR COURT PROBATE DIVISION Unit Docket No. In re Adoption of: CONSENT OF GUARDIAN OR AGENCY TO ADOPTION (Stepparent or Partner Adoption) I swear or affirm under oath that the facts set forth below are true and I consent to the adoption of the minor child named below. Information about Guardian or Representative of Agency signing the Consent: 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 M inor to be A dopted: Name: Date of Birth: Information about the Attorney Who R epresents the P rospective A doptive P arents: Name of Attorney: Phone: Address : City/State/Zip: I am: (C heck O ne B ox O nly) t he Guardian of this minor and my consent is required for his/her adoption. a duly authorized representative of an agency whose consent is required for the adoption of this minor . Information about the agency is as follows: Name of A gency : Phone: Address: City/State/ Zip: I, or my agency, obtained the authority to consent to the adoption in the following manner: ( D escribe ) American LegalNet, Inc. www.FormsWorkFlow.com 700 - 00139B - Consent of Guardian or Agency to Adoption (Stepparent or Partner Adoption) (0 4/2017 ) Page 2 of 2 Agreements I understand and agree that: ( C heck A ll T hat A pply ) The adoption will not terminate the parental relationship between the minor and the parent who is living with the stepparent. The adoption will terminate the parental relationship between the minor and the parent who is not living with the stepparent. The adoption will terminate any existing court order for custody, visitation or communication with the minor . Notwithstanding the adoption: A . T he mi nor and any descendant of the mi nor w ill retain ri g hts of inheritance from and throu g h the parent of the mi nor who is no t livin g wit h th e stepparent ; and B. A court order for parent child contact ( vi sitation or co mm unicat i on ) with the mi nor by either parent, or by a person related to the mi nor throu g h either paren t , or an a g ree m ent or order concerning another person which is appro v ed by the court under 15A V .S.A. 247 4 - 112, sur v i v es the decree of adoption, but failure to co m ply with the ter m s of the order or a g ree m ent is not a gr ound for re v o ki ng or setting aside this consent or the adoption; and C . T h e paren t wh o i s no t livin g wit h th e st e pparen t rem a in s liabl e fo r arrearage s o f child support unless relie v ed of that obli g ation by the parent who li v es with the stepparent, and any g uardian ad litem of the mi nor and by a g o ve rn m ental a g ency pro v iding public assistance to the mi nor. Waiver of Notice: ( C heck One B ox O nly) I w aive notice to m e or to m y a g ency of any further proceedin g s in the adoption of the m i nor child unless the adoption is contested, appealed, or denied. I do not w a i ve no ti ce to m e or to m y a g ency of any further proceedin g s in the adoption of the m i nor child. Voluntary Consent: I state for myself or on behalf of my agency that I voluntarily and unequivocally consent to the adoption of this minor child. 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