Fill and Sign the Fillable Online Courts State Ny Drl 1113 111 A61159 Form

D.R.L. §§115, 115-bForm 2-FJudicial Consent -Birth or Legal Parent -Private-Placement)8/2002SURROGATE’S COURT OF THE STATE OF NEW YORKCOUNTY OF____________________________In the Matter of the Adoption of (Docket)(File) No.A child whose First Name is JUDICIAL CONSENT(Birth or Legal Parent-- Private-Placement) ____________________________THIS CONSENT BECOMES IRREVOCABLE UPON EXECUTION ORACKNOWLEDGMENT BEFORE ANY JUDGE OR SURROGATE INNEW YORK STATE OR A COURT OF COMPETENT JURISDICTION INANOTHER STATE HAVING JURISDICTION OVER ADOPTIONPROCEEDING(S). NO ACTION OR PROCEEDING FOR THE CUSTODYOF THE ADOPTIVE CHILD MAY BE MAINTAINED BY THE PARENTEXECUTING OR ACKNOWLEDGING THE WITHIN CONSENT. ; optional]:1.I, [specify name]: , residing at , (birth)(legal)parent of [specify first name]: , do hereby consent to the adoption of my (daughter)(son) who was born on [specifydate]: (by [specify name(s); optional]: , adoptiveparent(s)).2. I have been advised that this consent becomes irrevocable when executed or acknowledgedbefore a judge or surrogate, and thereafter no action or proceeding may be maintained by me for thecustody of the child. I also have been advised that before I acknowledge or execute this consent, I havea right to be represented by a lawyer of my own choosing and, if I am financially unable to obtainsame, a lawyer will be assigned at public cost. I further have been advised that I have a right to obtainsupportive counseling.*3. The full name and last known address of the other (birth)(legal) parent of the adoptive childare:Dated:Signature: Form 2-f Page 2______________________________________/______________________________(Birth)(Legal) parent: typed or printed name/ signature______________________________________/________________________________Attorney if any: typed or printed name/signature______________________________________________________________________Attorney’s Address and Telephone numberState of)ss.:County of)On [specify date]: , [specify name]: personally appeared before me. (He)(She) is personally known to me or proved (his)(her) identity tome by satisfactory evidence as the person whose name is subscribed on this judicial surrender. (He)(She) acknowledged to me that (he)(she) executed this surrender. I have informed (him)(her) of theconsequences of the act of execution and acknowledgment pursuant to the provisions of section 115-bof the Domestic Relations Law and have informed (him)(her) of the right to be represented by legalcounsel of (his)(her) own choosing; of the right to obtain supportive counseling and of any rights toassigned counsel pursuant to section 262 of the Family Court Act, section 407 of the Surrogate's CourtProcedure Act, or section 35 of the Judiciary Law. I have given (him)(her) a copy of this consent uponexecution thereof.________________________________Judge of the Court(Seal of Court to be affixed together with Court Clerk's certification)