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Consent Of Stepparents Spouse (To Adoption) 139 - Vermont
| Consent Of Stepparents Spouse (To Adoption) Form. This is a Vermont form and can be used in Probate Court Statewide . |
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FORM 139. CONSENT OF STEPPARENT S SPOUSE STATE OF VERMONT PROBATE COURTDISTRICT OF _______________________ DOCKET NO. __________IN RE: ADOPTION OF ___________________________________________________ (a minor) CONSENT OF STEPPARENTS SPOUSE 15A V.S.A. 4-104 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 ProspectiveAdoptive Parent(s) With Whom I have Placed, or Intend to Place my Minor Child for Adoption: ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________.7. I state that I have legal and physical custody of my above-named minor child. I voluntarilyand unequivocally consent to the adoption of my minor child. 8. I understand and agree that the adoption will not terminate the parental relationship betweenmy minor child and me. 9. I understand and agree that the adoption will terminate the relationship of parent and childbetween my minor child and the minor childs other parent. 10. I understand and agree that the adoption will terminate any existing court order for custody,visitation, or communication with the minor child. 11. I understand and agree that notwithstanding the adoption: A. the minor and any descendant of the m winorill retain rights of inheritance from and through the minors other parent; B. a court order for visitation or communication with the minor by me, or by a person related to the minor through me, or an agreemor order concerningent another person which is approved by the court under 15A V.S.A. 4-112, survives the decree of adoption, but failure to comply with the terms of the order or agreement is not a ground for revoking or setting aside this consent or the adoption; <<<<<<<<<********>>>>>>>>>>>>> 2Form 139 Page 2 C. the other parent remains liable for arrearages of child support unless relieved of that obligation by me, and any guardian ad litem of the minor and by a governmental agency providing public assistance to the minor. 12. This consent is not, and cannot be, a waiver of any further notice to me of the proceeding for adoption of the minor child by the person seeking to adopt. 13. I swear that the factual informtion set forth in this consent is true and correct to the best ofa my knowledge and belief. Dated this ____ dayof ___________, 20___ at ______________________ in the County of ______________________________ and State of __________________________. ____________________________________________ (signature) ____________________________________________ (printed name) STATE OF ______________________________________ COUNTY OF ______________________________________ On the ____ dayof ___________, 20___, __________________________ personally appeared before me and signed or confirmed in my presence that he or she freely and voluntarily signed the above consent and acknowledged that the factual information set forth therein is true and correct to the best of his or her knowledge and belief. I am one of the following: _____ a Judge of a court that has jurisdiction over adoption proceedings in the State of ______________________; _____ a person appointed by a Probate Judgto take e consents or relinquishments; _____ a commissioned officer on active duty in the military service of the United States and the person signing the consent is in the military service; _____ an officer of the foreign service or a consular officer of the United States in another country, to wit: ___________________________________, and the person executing this consent appeared before me in that country; _____ a person authorized to take acknowledgments. ____________________________________________ (signature) ____________________________________________ (printed name)
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