Fill and Sign the P 420 Adoption Consent Child 10 or Older Probate Adoption Forms

Page 1 of 2 AS 25.23.060 -.070, .130 P-420 ( 12/16 )(cs) AS 25.24.310 ADOPTION CONSENT (CHILD 10 OR OLDER) Adoption Rule 9 IN THE SUPERIOR COURT FOR THE STATE OF ALASKA AT In the matter of the adoption of ) ) ) (child's name after adoption) ) DOB: , A Minor Child, ) ) CASE NO. By , ) Petitioner. ) ADOPTION CONSENT ) (CHILD 10 OR OLDER) 1. My name is . (child's current full name) 2. I am years old. 3. I understand that before I sign this consent I have the right to consult with an attorney of my choice, at my expense, or I may ask the court to appoint an attorney for me. 4. I consent to be adopte d by the petitioner named above. 5. I understand if this adoption is granted it will terminate parental rights between me and my biological mother father . It will also create the legal relationship of parent and child between me and the petitioner named above. 6. Visitation. I understand that no visitation privileges will be retained after adoption. may retain visitation with me after adoption. 7. I am am not a member of an Indian tribe ; or eligible for tribal membership and either of my biological parents is a member of an Indian tribe . 8. I understand I have a limited right to withdraw my consent. I understand that my consent cannot be withdrawn after the judge signs the decree of adoption. 9. I understand that the adoption petition has been or will be filed in the Superior Court at: Court Address: Co urt Telephone Number: 10 . I have received a copy of this consent (or will receiv e one after it is signed). 11. I am not married. married. My spouse is: Date Child's Signature (Signed in the presence of the court) Page 2 of 2 AS 25.23.060 -.070, .130 P-420 ( 12/16 )(cs) AS 25.24.310 ADOPTION CONSENT (CHILD 10 OR OLDER) Adoption Rule 9 CERTIFICATION BY COURT I certify that the terms and consequences of the abov e consent to adoption were explained in detail to the minor child in a language that the child understood and that the child understood these terms and consequences and voluntarily signed the consent. Date Superior Court Judge/Master Type or Pr int Name