Affidavit And Consent of Person Having Lawful Custody (Other than Birth or Legal Parent Private Placement)

To obtain the consent of the person who has legal custody over a child in an adoption case, this form has to be used. Present the completed and signed form to the court as a proof of consent.

Extracted Text for Proper Search

D.R.L. §§ 109(6), 111(1)(f),  Form 2-E
115(6) (Affidavit and Consent
 - Person Having Custody
 Private-Placement)
     8/2002
FAMILY 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
  AFFIDAVIT AND 
  CONSENT
              OF PERSON HAVING
              LAWFUL CUSTODY
  (Other than Birth
                          or Legal Parent-
  Private-Placement)
_____________________________________
STATE OF NEW YORK )
 ss.:
COUNTY OF                                     )
(I) (we) [specify name(s)]:
                                             (and                                                                                      ),
being duly sworn, depose(s) and say(s):
Deponent(s) reside(s) at
and (is)(are) the person(s) having lawful custody of the above-named adoptive child in that:
[recite facts showing how lawful custody was obtained]
Deponent(s) hereby consent(s) to said child's adoption by the petitioning adoptive parent(s)
(and                                                            ).
                                   ________________________________
    ________________________________

Form 2-E page 2	
______________________________________/______________________________
Affiant (Person Having Legal Custody) typed or printed name/ signature
______________________________________/________________________________
Attorney if any: typed or printed name/signature
______________________________________________________________________
Attorney’s Address and Telephone number	
STATE OF NEW YORK             )
        ss.:
COUNTY OF                         )
On [specify date]:                                       , [specify name]: 
 personally appeared before  me.  (He)(She) is personally known to me or proved (his)(her) identity to
me by satisfactory evidence as the person whose name is subscribed on this affidavit and consent. 
(He)(She) acknowledged to me that (he)(she) executed this affidavit and consent.
_______________________________
Notary Public
STATE OF NEW YORK            )
     ss.:
COUNTY OF                              )
On [specify date]:                                       , [specify name]: 
 personally appeared before  me.  (He)(She) is personally known to me or proved (his)(her) identity to
me by satisfactory evidence as the person whose name is subscribed on this affidavit and consent. 
(He)(She) acknowledged to me that (he)(she) executed this affidavit and consent.
_______________________________
Notary Public