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Consent to Stepparent Adoption (from Petitioners Spouse)

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Page 	1 of 	2 	
P-410 (	5/12	)(cs) 	AS 25.23.060	-.070	 	
In 	the matter of the adoption of	 	) 	
 	, 	) 	
 	(child's name after adoption)	 	) 	
DOB:	 	 , A Minor Child,	 	) 	
By	 	, 	) 	CASE NO. 	 	 	
 	Petitioner.	 	) 	
1. 	I,  	, am the biological	 	 mother	 	 father	 	
 	of 	 	. 	
 	(child's current full name)	 	
2. 	I  understand  that  prior  to  signing  this  consent  I  have  the  right  to  consult  with  an 
attorney of my choice, at my expens	e. 	
3. 	I consent to the adoption of	 the above	-named child by my	 	 husband	 	 wife,	 	
who  is the  petitioner named  above.    I  do  not,  however,  give  up  any  of my  rights, 
duties or obligations as the child's legal parent.	 	
4. 	I unde	rstand I have a limited right to withdraw my consent.  I understand that my 	
consent  cannot  be  withdrawn  after  the  judge  signs  the  decree  of  adoption.  
However,  before  the  adoption  decree  is  signed,  I  can  withdraw  my  consent  as 
a. 	Within  10  days  a	fter  I  sign  this  form,  I  can  deliver  written  notice  to  the 	
court  at  the  address  in  paragraph  5  or  to  the  person  who  obtained  my 
consent.  This written notice must be delivered or postmarked by the tenth 
b. 	After the above 10	-day period, if the decree	 has not been signed, I can file 	
a  request  to  withdraw  with  the  court,  which  the  court  may  or  may  not 
grant.  My request will be granted only if the court finds that it is in the best 
interests of the child after both the petitioner and I are given notice 	and an 	
opportunity to be heard.	 	
5. 	I understand that the adoption petition will be filed in the Superior Court at:	 	
 	Court Address: 	 	 	
 	Co	urt Telephone Number:

Page 	2 of 	2 	
P-410 (	5/12	)(cs) 	AS 25.23.060	-.070	 	
6. 	The  child  is  not  a  member  of  an  Indian  tribe  or  an  Alaska  Native  Village.    In 
addition,  th	e  child  is  not  eligible  for  such  membership,  and  neither  of  the  child's 	
biological parents is a member of an Indian tribe or an Alaska Native Village. 	 	
7. 	This  consent  is  effective  as  a  power  of  attorney  under  AS  13.26.020,  delegating 
to  petitioner  parent	al  authority  over  the  care,  custody  and  property  of  the  minor 	
child  during  the  pendency  of  the  adoption  proceeding.    However,  I  understand 
that  this  delegation  does  not  affect  my  own  parental  rights,  duties  or  obligations 
toward the child.	 	
8. 	I 	 am	 	 am not	 	a 	minor.  My date of birth is 	 	. 	
9. 	I  acknowledge  that  I  have  received  a  copy  of  this  consent  (or  will  receive  one 
after it is signed).	 	
I  state  on  oath  or  affirm  that  I  have  read  this  consent  form  and  bel	ieve  all  statements 	
made in it are true.	 	
 	Date	 	 	Signature of Parent Giving Consent	 	
 	 	Mailing Address	 	
 	City	 	State	 	Zip	 	
 	Daytime Phone	 	
On 	 	,  	 personally appeared	 	
 	(date)	 	(name)	 	
before me in 	 	,  Alaska,  signed  the  abo	ve  consent  to 	
adoption,  certified  under  oath  or  affirmation  that  he/she  has  read  it  and  believes  its 
contents  to  be  true,  and  acknowledged  that  he/she  signed  the  consent  freely  and 
voluntarily for the purposes stated therein.	 	
 	Clerk  of  Court,  Not	ary  Public  or  other 	
person authorized to administer oaths.	 	
 	My commission expires:
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