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Affidavit and Consent

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AFFIDAVIT AND CONSENT FORM

D.R.L. §§ 109(6), 111(1)(f),
115(6)

Form 2-E
(Affidavit and Consent
- Person Having Custody
Private-Placement)
8/2002

SURROGATE'S 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.

AFFIDAVIT AND CONSENT
OF PERSON HAVING LAWFUL CUSTODY
(Other than Birth or Legal Parent-Private-Placement)

STATE OF NEW YORK

)

ss.:

COUNTY OF

)

(I) (we) [specify name(s)]:

(and ),

being duly sworn, depose(s) and say(s):

Deponent(s) reside(s) at

and (is)(are) the person(s) having lawful custody of the above-named adoptive child in that:

Deponent(s) hereby consent(s) to said child's adoption by the petitioning adoptive parent(s)
(and ).

Form 2-E page 2

Affiant (Person Having Legal Custody) typed or printed name/ signature

Attorney if any: typed or printed name/signature

Attorney's Address and Telephone number

STATE OF NEW YORK

)

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 affidavit and consent. (He)(She) acknowledged to me that (he)(she) executed this affidavit and consent.

Notary Public

STATE OF NEW YORK

)

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 affidavit and consent. (He)(She) acknowledged to me that (he)(she) executed this affidavit and consent.

Notary Public

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What an Affidavit and Consent Is

An Affidavit and Consent is a sworn written statement in which an affiant affirms facts under oath and provides express consent for a specified action or legal effect. Common uses include parental travel consent, consent to release records, declarations of service, and statements supporting court filings. The document typically combines a factual affidavit (facts presented under penalty of perjury) with a clear consent clause describing the scope, duration, and recipient of that consent. Proper execution, identification of the affiant, and any required notarization or witnessing determine legal effect and admissibility.

Why an Affidavit and Consent Matters

It creates a verifiable record of sworn facts plus permission for a defined action, which supports legal processes, reduces disputes, and documents informed agreement where third parties or authorities require proof of consent.

Why an Affidavit and Consent Matters

Who Typically Completes an Affidavit and Consent

Individuals and authorized representatives prepare and sign these documents when a sworn statement plus explicit consent is required by a third party or a tribunal.

  • Parents or legal guardians providing travel or medical consent for a minor.
  • Business officers or agents granting consent for contract performance or records release.
  • Attorneys and notaries preparing sworn statements for court or administrative use.

Step-by-Step: Completing an Affidavit and Consent

Follow these practical steps to prepare, verify, and execute the affidavit so it is admissible and enforceable.

  • 01
    Draft Facts: List clear factual statements in numbered paragraphs.
  • 02
    Specify Consent: Describe the consent scope, recipient, and duration.
  • 03
    Verify Identity: Match the affiant's name and ID before notarization.
  • 04
    Notarize: Sign before the notary or follow RON procedures where permitted.

Common Questions and Troubleshooting

Answers to frequent questions about execution, validity, notarization, correcting errors, and the interaction between sworn statements and electronic signing.


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Security, Compliance, and Technical Protections

Encryption: AES-256 at rest
In-transit Security: TLS 1.2/1.3
Authentication: Multi-factor options available
Certifications: SOC 2 Type II, ISO 27001
Regulatory Compliance: ESIGN, UETA, 21 CFR Part 11
Healthcare Handling: HIPAA (BAA required)

Key Risks and Potential Penalties

Perjury Exposure: Criminal penalties
Admissibility Loss: Document rejected in court
Contract Voidance: Consent may be unenforceable
Regulatory Fines: Agency penalties possible
Delay Costs: Process and filing delays
Identity Disputes: Additional verification required

Common Preparation Mistakes to Avoid

  • Using ambiguous consent language that fails to specify the recipient, duration, or limits of the consent and creates interpretive disputes.
  • Failing to verify identification or using inconsistent names between the affidavit and supporting ID, causing notarization or admissibility problems.
  • Submitting an unsigned or improperly witnessed document when the jurisdiction or recipient specifically requires a notarized jurat or witness attestations.
  • Relying on unsigned email confirmations or informal consent where a sworn affidavit is required by the receiving party or court.

Core Components of a Professional Affidavit and Consent

A well-drafted affidavit and consent contains discrete, verifiable elements that support sworn accuracy and clear authorization.

Caption

Document identification including title, case or file number if applicable, and an explicit statement that this instrument is an Affidavit and Consent to provide context for reviewers and courts.

Affiant Statement

A clear declarative paragraph where the affiant states personal capacity and relationship to the matter, confirming the source of knowledge and basis for the factual statements that follow.

Factual Paragraphs

Numbered, concise factual assertions presented in plain language. Each paragraph should state a single fact that the affiant witnessed or can verify personally.

Consent Clause

Explicit language granting permission, naming the recipient, defining permitted actions, specifying any limits or expiration, and stating whether consent may be revoked.

Signature and Date

Affiant's handwritten or electronic signature accompanied by the execution date in MM/DD/YYYY format and any required initials or witness acknowledgements.

Notary/Witness Block

A jurat or acknowledgement where required, including notary signature, seal, commission details, and any witness signature lines required by the receiving jurisdiction.

Where to File or Send an Executed Affidavit and Consent

Identify the receiving party or filing office before execution to confirm notarization, witness, and submission requirements and to avoid rework.

  • Court Filing: Submit per local court clerk rules.
  • Agency Submission: Follow agency-specific submission instructions.
  • Recipient Service: Send to named entity or individual contact.
  • Record Retention: Retain executed copies per retention rules.

Typical Digital Workflow Settings for an Affidavit and Consent

When preparing the document for electronic completion, configure fields and authentication to match legal and recipient requirements.

Field Configuration
Authentication Method Email link, SMS code, or advanced ID verification
Notary / RON Enable RON where state rules permit and recording is retained
Document Format Upload PDF or DOCX; lock text after placement
Routing Order Set signer sequence and add conditional routing

Technical and Integration Considerations

Confirm file formats, authentication needs, and integrations before sending an electronic affidavit to ensure the recipient accepts e-signed and notarized documents.

  • Integrations: Salesforce, NetSuite, Microsoft 365, Google Workspace
  • File Formats: PDF and DOCX supported
  • Authentication: Email, SMS, KBA, RON where available

Time-Sensitive Considerations and Deadlines

Certain uses of an affidavit and consent are time-sensitive; confirm submission deadlines tied to court, agency, or contractual events.

Before Effective Date:

Execute and notarize prior to the action date

Court Filing Windows:

Follow local rules for filing and service deadlines

Agency Time Limits:

Adhere to agency-specific submission periods

Statute of Limitations:

Preserve evidence within applicable limitation periods

RON Recording Retention:

Retain audio-video recording per state rule

Key Processing Milestones

A typical processing timeline highlights milestones from drafting through final retention so stakeholders can track completion and compliance.

01

Drafting Completed

Affiant prepares factual paragraphs and consent language

02

Identity Verified

ID check or KBA performed before signing

03

Execution and Notarization

Document signed and notarized or RON session completed

04

Distribution and Retention

Copies distributed and original retained per policy

eSignature Platform Pricing Snapshot for Affidavit and Consent Workflows

Comparing basic pricing and compliance features helps determine which eSignature provider aligns with notarization, HIPAA, and volume needs for affidavits and consents.

signNow DocuSign Adobe Sign PandaDoc HelloSign
Starting Price $8/user/mo $15/user/mo $14/user/mo $19/user/mo $15/user/mo
Free Trial 7-day free trial, no credit card Varies by vendor Varies by vendor Varies by vendor Varies by vendor
Bulk Send Yes Plan-dependent Plan-dependent Plan-dependent Plan-dependent
Audit Trail Yes Yes Yes Yes Yes
HIPAA Compliant Yes Yes Yes No No

Practical Use Cases for an Affidavit and Consent

Two common scenarios illustrate how an affidavit and consent are used in practice and why proper execution matters.

Parental Travel Consent

A parent creates a sworn statement authorizing international travel

  • Identifies child, traveling adult, dates, and scope
  • Proper notarization and a clear consent clause avoid airline or border delays and provide verifiable proof of parental authorization.

Affidavit of Service

A process server signs an affidavit describing service of papers

  • Details who was served and when
  • Courts typically require a notarized affidavit of service to verify proper notice and preserve procedural rights.

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