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Consent Of Minor In Stepparent Adoption 139D - Vermont
| Consent Of Minor In Stepparent Adoption Form. This is a Vermont form and can be used in Probate Court Statewide . |
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Probate Court Form No. 139D Consent of Minor In Stepparent Adoption STATE OF VERMONT PROBATE COURTDISTRICT OF _______________________ IN RE THE ADOPTION OF _____________________ DOCKET NO. __________________ ( minor) CONSENT OF MINOR IN STEPPARENT ADOPTION 15A V. S. A. 4-103 1. My Full Name _______________________________________. 2. My Mailing Address __________________________________ __________________________________ __________________________________ 3. My Date of Birth __________________________________ 4. The Name of the Stepparent Who is Seeking to Adopt Me: ____________________________________________________ 5. I voluntarily and unequivocally consent to the adoption of me by my stepparent. Dated this _____ day of _____________________, 20 ____ at __________________ in the Countyof _______________________and State of Vermont. ________________________________ (Signature) ________________________________ (Print Name) 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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