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-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)
12/97
SURROGATE'S 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.
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]: [FN*] (by [specify name(s)]:,
						adoptive parent(s)).
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
/
_________________________
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
State of)
ss.:
County of)
On this day of 19 ,
, the person who executed the foregoing
						instrument, personally came before me and (he)(she) acknowledged that (he)(she)
						executed the same. I have informed such person 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)
[FN*] Optional