Fill and Sign the Consent of Stepparents Spouse Vermont Form

STATE OF VERMONT PROBATE COURT DISTRICT OF ____________ In Re the Estate of: ) DOCKET No. __________ ) __________________ ) , Deceased ) ) ) LATE OF ) ) __________________ . ) ) ) CONSENT TO STEPPARENT'S SPOUSE 15A V.S.A. § 4-404 1. My Full Name Name 2. My Mailing Address ____________________ ____________________ ____________________ 3. My Date of Birth ____________________ 4. Full Name of Minor Who Is Being Adopted Name . 5. Date of Birth of Minor Who Is Being Adopted ____________________ . 6. Full Name, Address and Telephone Number of the Attorney Representing the Prospective Adoptive Parent(s) With Whom I have Placed, or Intend to Place my Minor Child for Adoption: ____________________ ____________________ ____________________ 7. I state that I have legal and physical custody of my above- named minor child. I voluntarily and unequivocally consent to the adoption of my said minor child. - 1 - 8. I understand and agree that the adoption will not terminate the relationship of parental relationship between my minor child and me. 9. I understand and agree that the adoption will terminate the relationship of parent and child between my minor child and the minor child's other parent. 10. I understand and agree that the adoption will terminate any existing court order for custody, visitation, or communication with the minor child. 11. I understand and agree that notwithstanding the adoption: A. the minor and any descendent of the minor will retains rights of inheritance from and through the minor's other parent; B. B. a court order for visitation or communication with the minor by me, or by a person related to the minor through me, or an agreement or order concerning another person which is approved by the court under 15A V.S.A. § 4-112, survives the decree of adoption, but failure to comply with the terms of the order or agreement is not a ground for revoking or setting aside this consent or the adoption; C. the other parent remains liable for arrearages of child support unless relieved of that obligation by me, and any guardian ad litem of the minor and by a governmental agency providing public assistance to the minor. 12. This consent is not, and cannot be, a waiver of any further notice to me of the proceeding for adoption of the minor child by the person seeking to adopt. 13. I swear that the factual information set forth in this consent is true and correct to the best of my knowledge and belief. Dated this _______ date of _______________, 20____ at _______________ in the County of __________ and State of ____ . ___________________________________________________________ (signature) _____________________________________________________________ (printed name) - 2 - STATE OF ST COUNTY OF County On __________ day of _______________ , 20       , ____________________ personally appeared before me and signed or confirmed in my presence that he or she freely and voluntarily signed the above consent and acknowledged that the factual information set forth therein is true and correct to the best of his or her knowledge and belief. I am one of the following: a Judge of a court that has jurisdiction over adoption proceedings in the State of ST ; a person appointed by a Probate Judge to take consent or relinquishments; a commissioned officer on active duty in the military service of the United States and the person signing the consent is in the military service; an officer of the foreign service or a consular officer of the United States in another country, to wit: ____________________ , and the person executing this consent appeared before me in that country; a person authorized to take acknowledgments. ___________________________________________________________ (signature) _____________________________________________________________ (printed name) Rev.3/1/97 - 3 -