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Fill and Sign the Justia Extra Judicial Consent Birth or Legal Parent Form

Fill and Sign the Justia Extra Judicial Consent Birth or Legal Parent Form

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Open the document and fill out all its fields.
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D.R.L. §§ 115, 115-b(8) Form 2-Ga (Extrajudicial Consent Birth or Legal Parent - Private-Placement Step-parent) 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 EXTRAJUDICIAL CONSENT (Birth or Legal Parent - Private-Placement - Step-parent) ______________________________1. I, , residing at , am the (birth) (legal) parent of . I do hereby consentto the adoption of my (daughter) (son) , born on by [specify name]: , adoptive parent.2. The name and last known address of the other (birth)(legal) parent of the adoptive child are[delete if inapplicable]:Dated:______________________________/_____________________________________(Birth)(Legal) Parent: typed or printed name/ signature_____________________________________/________________________________Attorney if any: typed or printed name/signature______________________________________________________________________Attorney’s Address and Telephone numberSTATE 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 tome by satisfactory evidence as the person whose name is subscribed on this extrajudicial surrender. (He)(She) acknowledged to me that (he)(she) executed this surrender.____________________________ Notary Public

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