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Fill and Sign the Form 2 D Download Fillable PDF Consent of Child over 14

Fill and Sign the Form 2 D Download Fillable PDF Consent of Child over 14

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D.R.L. § 111(1) (a)Form 2-D(Consent of Child - Private-Placement)8/2002SURROGATE’S COURT OF THE STATE OF NEW YORKCOUNTY OF................................................................................................In the Matter of the Adoption of A Child(Docket)(File) No.Whose first Name IsCONSENT OF CHILD OVER 14(Private-Placement)................................................................................................The undersigned adoptive child, who is years old, having been born on ,hereby consents to (his) (her) adoption by ) , thepetitioning adoptive parent(s) in the above-entitled proceeding. Dated: ______________________________________Child______________________________________/______________________________Adoptive Parent: typed or printed name/ signature______________________________________/_______________________________Adoptive Parent: typed or printed name / signature_______________________________________________/_______________________Adoptive child if over 14: typed or printed name/ signature______________________________________/________________________________Attorney if any: typed or printed name/signature______________________________________________________________________Attorney’s Address and Telephone number Form 2-D page 2STATE 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 meby satisfactory evidence as the person whose name is subscribed on this consent. (He)(She) acknowledgedto me that (he)(she) executed this consent._______________________________________Notary PublicSTATE OF NEW YORK)ss.:COUNTY OF)On this day of , , before me personally came proven to me by the oath of an attorneyadmitted to practice in the State of New York to be the person described in and who executed the foregoinginstrument and duly acknowledged thatexecuted the same.___________________________________Judge of the Court

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