Judicial Consent Of Birth Of Legal Parent To Adoption By Step-Parent) {2-Fa}

D.R.L. §§115, 115-b(8) Form 2-Fa (Judicial Consent of Birth or Legal Parent to Adoption by Step-parent) 9/2009 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 OF BIRTH OR LEGAL PARENT TO ADOPTION BY STEP-PARENT ___________________________________ 1. I, [specify name]: , Q birth Qlegal parent of [specify first name of child]: of my Qdaughter Qson, 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 Qbirth Qlegal parent of the adoptive child are [optional]: Dated: ____________________________________________/_________________________ QBirth QLegal Parent: type or print name / Signature ______________________________________/________________________________ Attorney if any: type or print name /signature ______________________________________________________________________ Attorney's Address and Telephone number State of County of On [specify date]: , [specify name]: personally appeared before me. Q He QShe is personally known to me or proved Qhis Qher identity to me by satisfactory evidence as the person whose name is subscribed on this judicial surrender. Q He Q She acknowledged to me that Q he Q she executed this surrender. ) : ss.: ) Judge of the _____________________ (Seal of Court to be affixed together with Court Clerk's certification) Court American LegalNet, Inc. www.FormsWorkFlow.com