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Consent Of Guardian Or Agency In Stepparent Adoption 139B - Vermont
| Consent Of Guardian Or Agency In Stepparent Adoption Form. This is a Vermont form and can be used in Probate Court Statewide . |
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FORM 139B. CONSENT OF GUARDIAN OR AGENCY IN STEPPARENT ADOPTION STATE OF VERMONT PROBATE COURTDISTRICT OF _______________ DOCKET NO. _________IN RE: ADOPTION OF _______________________________________________________ CONSENT OF GUARDIAN OR AGENCY IN STEPPARENT ADOPTION 15A V.S.A. 4-106 1. My Full Name _____________________________________________________________2. My Mailing Address ____________________________________________________ ____________________________________________________ ____________________________________________________.3. My Date of Birth __________________________________________. 4. Full Name of Minor Who Is Being Adopted ____________________________________.5. Date of Birth of Minor Who Is Being Adopted ____________________________.6. Full Name, Address and Telephone Number of the Attorney Representing the Prospective Adoptive Parent(s) With Whom I have Placed, or Intend to Place my Minor Childfor Adoption: ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________7. I am either: _____ A. the Guardian of the above-named minor child and my consent is required for the adoption of the minor; or _____ B. a duly authorized representative of an agency whose consent is required for the adoption of the minor child. The agency name and address is as follows: ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________8. I, or my agency, obtained the authority to consent to the adoption in the followingmanner: ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________9. I understand and agree that the adoption will not terminate the parental relationship betweenthe minor and the parent who is living with the stepparent. 10. I understand and agree that the adoption will terminate the parental relationship between theminor and the parent who is not living with the stepparent. 11. I understand and agree that the adoption will terminate any existing court order for custody,visitation or communication with the minor but <<<<<<<<<********>>>>>>>>>>>>> 2Form 139B Page 2 A. the minor and any descendant of the minor will retain rights of inheritance from and through the parent of the minor who is not living with the stepparent; and B. a court order for visitation or communication with the minor by either parent, or by a person related to the minor through either parent, or an agreement or order concerning another person which is approved by the court under 15A V.S.A. 4-112, survives the decree of adoption, but failure to compwith the termly s of the order or agreement is not a ground for revoking or setting aside this consent or the adoption; C. the parent who is not living with the stepparent remains liable for arrearages of child support unless relieved of that obligation by the parent who lives with the stepparent, and any guardian ad litem of the minor and by a grnmoveental agency providing public assistance to the minor. 12. I do one of the following: _____ I waive notice to me or to my agency of any further proceedings in the adoption of the minor child unless the adoption is contested, appealed, or denied. _____ I do not waive notice to me or to my agency of any further proceedings in the adoption of the minor child. 13. I state for myself or on behalf of my agency that I voluntarily and unequivocally consent to the adoption of the said minor child. 14. I swear that the factual information set forth in this consent is true and correct to the best of my knowledge and belief. Dated this ____ dayof ___________, 20___ at ______________________ in the County of _____________________ and State of _______________________. ____________________________________________ (signature) ____________________________________________ (printed name) ____________________________________________ (Agency name, if applicable) Signed and confirmed in the presence of the Judge or in the presence of a person directed by the Judge. ____________________________________________ (signature) ____________________________________________ (printed name) ____________________________________________ (title)
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