Consent of Partner

In the State of Vermont, this form is used in an Adoption proceeding involving a minor.Download

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Probate Court Form No. 139E
Consent of Spouse, Partner Prospective
Parent in Adoption
STATE OF VERMONT  PROBATE COURT
DISTRICT OF ___________________                                           DOCKET  NO. ________________
IN RE ADOP TION OF _________________
CONSENT OF SPOUSE OR PARTNER OF PROSPECTIVE ADOPTIVE PARENT IN ADOPTION OF ADULT OR EMANCIPATED MINOR 15 V. S. A. 5-105
1. My Full Name ___________________________________
2. My Mailing Address ____________________________ ____________________________
____________________________
3. My Date of Birth ____________________________
4. Full Name of Adult or Emancipa ted Minor Who is Being Adopted.
_____________________________________________________
5. Full Name of Prospective Adoptive Parent.  ______________________________________________________
6. (a) I State That the Prospective Adoptive Parent and I are Married and  The Date of Ou r Marriage Was _____________________________
(b) I have been prospective Adoptive Parent’s Partner since
_______________________, and I consent to the adoption.
7. I consent to the adoption of the above named adult or emancipated minor by my spouse.
8.   I understand the consequences the adoption may have for any right of inheritance, property, or support I have.
9. I acknowledge that I have received a copy of this consent.
10. I do one of the following: _______ I waive notice to me of any further proceedings in this adoption  unless the adoption is cont ested, appealed or denied.
_______ I do not waive notice of any further proceedings in this adoption.
I swear that the factual information set fort h in this consent is true and correct to
the best of my knowledge and belief..
Dated: __________________________ Signed _____________________________
Print Name: _________________________

STATE OF VERMONT
COUNTY OF _______________________On the _____ day of ____________ 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 jurisdic tion over adoption proceedings in the
State of Vermont;
________ a person authorized to take acknowledgments.
_____________________________
               (Signature)
_____________________________(Printed Name)