New York Codes, Rules and Regulations
Title 22 - JUDICIARY
Subtitle D - Forms
Chapter VII - Surrogate's Court Forms
Subchapter B - Adoption Forms Of The Surrogate's Court
Adoption Forms
Form 2-B - Agreement of adoption (private-placement)
D.R.L. §§ 111(1)(f), 115(4) Form 2-B
(Agreement of Adoption
Private-Placement)
12/97
COURT OF THE STATE OF NEW YORK
COUNTY OF
________
In the Matter of the Adoption of (Docket) (File) No.
A Child whose First Name is
AGREEMENT OF
ADOPTION
(Private-Placement)
________
The undersigned petitioning adoptive parent(s) hereby agree(s) to adopt the above-named adoptive child and to treat said child in all respects as (his) (her) (their) own lawful child and to extend and assure to said child all the rights, benefits and privileges incident to such relationship, and to incur and fulfill all the responsibilities of (a) parent(s) with respect to said child.
Dated:
/
_________________________
Adoptive Parent: typed or printed name/signature
/
_________________________
Adoptive Parent: typed or printed name/signature
/
_________________________
Adoptive child if over 18: typed or printed name/signature
/
_________________________
Attorney if any: typed or printed name/signature
_________________________
Attorney's Address and Telephone number
Form 2-B page 2
STATE OF NEW YORK)
ss:
COUNTY)
On this day of, 19,, the person who executed the foregoing instrument, personally came before me and acknowledged that (he)(she) executed the same.
______________
Notary Public
STATE OF NEW YORK)
ss:
COUNTY)
On this day of, 19,, the person who executed the foregoing instrument, personally came before me and acknowledged that (he)(she) executed the same.
______________
Notary Public
STATE OF NEW YORK)
ss:
COUNTY)
On this day of, 19, proven to me by the oath of, an attorney admitted to practice in the State of New York, to be the person(s) who executed the foregoing instrument, personally came before me and acknowledged that (he)(she) executed the same.
________
Judge of the Court
