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-Fa - Judicial consent (birth or legal parent - private-placement - step- parent)
D.R.L. §§ 115, 115-b(8) Form 2-Fa
(Judicial Consent -
Birth or Legal Parent-
Private-Placement
Step-parent)
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
JUDICIAL CONSENT
(Birth or Legal Parent--
Private-Placement-
Step-parent)
________
1. I, [specify name]: , residing at
, (birth)(legal) parent of
[specify first name of child]: , do hereby consent to the adoption of my (daughter) (son), who was born on [specify date] by [specify name]:
, adoptive parent.
2. The full name and last known address of the other (birth) (legal) parent of the adoptive child are: [FN1]
Dated:
/
_________________________
(b) . The adoptive parent(s) (has)(have) (no) knowledge of any criminal record concerning themselves or any other adult residing in the household (except)
/
_________________________
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-fa Page 2
State of )
: ss.:
County of )
On this day of , 19 ,
the person described in and who executed the foregoing instrument personally came before me and acknowledged that (he)(she) executed the same.
________
Judge of the Court
__________
(Seal of Court to be
affixed together
with Court Clerk's
certification)
[FN1] Optional
