Fill and Sign the Pursuant to 19 5 2031d Form

JDF 508 1/18 CONSENT TO ADOPTION – SOLE LEGAL PARENT District Court Denver Juvenile Court___________________County, ColoradoCourt Address:In the Matter of the Petition of:______________________________ (name of person seeking to adopt)For the Adoption of a Child COURT USE ONLY Attorney or Party Without Attorney (Name and Address): Phone Number: E-mail:FAX Number: Atty. Reg. #:Case Number:Division Courtroom CONSENT TO ADOPTION – SOLE LEGAL PARENT PURSUANT TO §19-5-203(1)(d.5)(I), C.R.S. 1.I certify that I am the sole legal parent of _______________________________ (name of child). 2. I have received a copy of the Petition for Second Parent Adoption and Notice of Hearing. 3. I certify that I am voluntarily consenting to the adoption of the child by the above-named Petitioner. VERIFICATION I declare under penalty of perjury under the law of Colorado that the foregoing is true and correct.Executed on the ______ day of ________________, _______, at ______________________________________ (date) (month) (year) (city or other location, and state OR country___________________________________ ______________________________________ (printed name of Petitioner) Signature