Legal Forms > Family Related
Withdrawal Of Parental Consent To Adoption - Legal Forms
| Withdrawal Of Parental Consent To Adoption Form. This is a Legal Forms form and can be used in Family Related . |
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WITHDRAWAL OF PARENTAL CONSENT TO ADOPTION On ___________ (Date), I, _____________________________, the ______________ (Father/Mother) of ____________________________, a ___________ (Male/Female) child born on _____________ (Date), consented to ________ (His/Her) adoption by ____________________________________ and _____________________________(Adoptive Parents). I declare my intention to revoke my consent to said adoption agreement on the grounds that the following changes in my circumstances establish it to be in the best interest of ___________________________ (Child) to remain in my care and custody: _____________________________________________________ _____________________________________________________. Therefore, I do hereby revoke my consent to the adoption agreement and declare said adoption agreement to be void and of no further effect. In witness whereof, I have signed this instrument at ____________________________ (Place of Execution). _________________________________ Signature __________________ Date This document was signed in the presence of the following: _________________________________ Signature _________________________________ Signature __________________ Date __________________ Date 2001 © American LegalNet, Inc.
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