Agreement of Adoption

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TO:COURT OFPROBATE, DISTRICTNO.
Guardian ofthe person ofminor child:Name:
Statutory parent[Name andaddress oflocal office]
AGREEMENT
OFADOPTION
PC-681 REV.10/00 STATE
OFCONNECTICUT
COURT OFPROBATE
[ Type orprint inblack ink.File induplicate .]
IN THE MATTER OF[Give firstname only.] .
A MINOR CHILD, BORNON
ADOPTING PARENT(S)
PERSON
GIVINGMINORCHILDINADOPTION C.G.S.§45a-724
The PERSON GIVINGTHEMINOR CHILDINADOPTION, beingaperson whomaygive achild inadoption asby statute is
provided, doesgiveinadoption theMINOR CHILDnamedabovetothe ADOPTING PARENT(S), andtheADOPTING PARENT(S)do
hereby adoptandreceive saidMINOR CHILDastheir legal child.
The PERSON GIVINGTHEMINOR CHILDINADOPTION	
and theADOPTING PARENT(S)representthateach islaw-
fully entitled toenter intothisagreement ofadoption.
The PERSON GIVINGTHEMINOR CHILDINADOPTION, beingaparent ofsaid MINOR CHILD, inno way relinquishes any
parental rightinand tosaid MINOR CHILD.
The name ofsaid MINOR CHILDshallbechanged to:
agreement shalltakeeffect uponitsapproval bythe Court ofProbate forthe District of
Residing
at ,Connecticut06
MINOR CHILD'S CONSENT TOADOPTION
I hereby consent tothe above-written AgreementofAdoption.
SIGNED........................................................................\
.......................
AGREEMENT OFADOPTION
PC-681	
GIVING MINORCHILDINADOPTION ADOPTINGPARENT(S)
........................................................................\
..
[USE ONLY IFMINOR CHILDISTWELVE YEARSOFAGE OROLDER. C.G.S.§45a-724.]
        COMPLETE ONE ONLY
This
PERSON ........................................................................\
..
........................................................................\
.....
Signature Signature
Signature
PRESENTLY RESIDING AT:
Parentofminor child of
Parent ofminor child of
by
its	
........................................................................\
..... Signature TOWN:
COUNTY:
STATE:
Print Name:
Print Name: Print Name:
Print Name:
Dated at: ,Connecticut, on [Month, Day, Year]
Print Name: CONFIDENTIAL