New York Codes, Rules and Regulations › Title 22 - JUDICIARY › Subtitle D - Forms › Chapter IV - Forms of the Family Court of the State of New York and Adoption Forms of the Family Court of the State of New York (cf. s205.7) › Subchapter B - Adoption Forms Of The Family Court › Adoption Forms › Form 2-F - Judicial consent (birth or legal parent - private-placement)

Current through Register Vol. 46, No. 28, July
					 10, 2024
D.R.L. §§ 115, 115-b Form
						2-F
(Judicial Consent -
Birth or Legal Parent--
Private-Placement)
8/2002
FAMILY 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)
________
THIS CONSENT BECOMES IRREVOCABLE UPON
						EXECUTION OR ACKNOWLEDGMENT BEFORE ANY JUDGE OR SURROGATE IN NEW YORK STATE OR
						A COURT OF COMPETENT JURISDICTION IN ANOTHER STATE HAVING JURISDICTION OVER
						ADOPTION PROCEEDING(S). NO ACTION OR PROCEEDING FOR THE CUSTODY OF THE ADOPTIVE
						CHILD MAY BE MAINTAINED BY THE PARENT EXECUTING OR ACKNOWLEDGING THE WITHIN
						CONSENT.
; optional]:
1. I, [specify name]:, residing at,
						(birth)(legal)
parent of [specify first name]:
, do hereby consent to the adoption of my
						(daughter) (son) who was born on specify date]:
(he) (she) executed the same.
2. I have been advised that this consent
						becomes irrevocable when executed or acknowledged before a judge or surrogate,
						and thereafter no action or proceeding may be maintained by me for the custody
						of the child. I also have been advised that before I acknowledge or execute
						this consent, I have a right to be represented by a lawyer of my own choosing
						and, if I am financially unable to obtain same, a lawyer will be assigned at
						public cost. I further have been advised that I have a right to obtain
						supportive counseling.
*3. The full name and last known address
						of the other (birth) (legal) parent of the adoptive child are:
Dated: Signature:
Form 2-F Page 2
/
_________________________
(Birth) (Legal) parent: typed or printed
						name/signature
/
_________________________
Attorney if any: typed or printed
						name/signature
_________________________
Attorney's Address and Telephone
						number
State of)
ss.:
County of)
On [specify date]:, [specify name]:
						personally appeared before me. (He)(She) is personally known to me or proved
						(his)(her) identity to me by satisfactory evidence as the person whose name is
						subscribed on this judicial surrender. (He)(She) acknowledged to me that
						(he)(she) executed this surrender. I have informed (him)(her) of the
						consequences of the act of execution and acknowledgment pursuant to the
						provisions of section
						115-b
						of the Domestic Relations Law and have informed (him)(her) of the right to be
						represented by legal counsel of (his)(her) own choosing; of the right to obtain
						supportive counseling and of any rights to assigned counsel pursuant to section
						262 of the
						Family Court Act, section
						407 of the Surrogate's Court Procedure Act,
						or section
						35 of the
						Judiciary Law. I have given (him)(her) a copy of this consent upon execution
						thereof.
________
Judge of the Court
(Seal of Court to be affixed together with
						Court Clerk's certification)