Free Microsoft Word - P-420 Consent to tepparnet Adoption _Child's Consent_ _4-9... - Alaska

IN THE SUPERIOR COURT FOR THE STATE OF ALASKA AT In the matter of the adoption of ) ) ) ) ) ) ) ) ) CASE NO. ) ) CONSENT TO STEPPARENT ADOPTION (Consent of Child Age 10 or Older) . (child's current full name) 2. 3. I am years old.

, (child's name after adoption) DOB: , A Minor Child, By , Petitioner.

1.

My name is

I understand that before I sign this consent I have the right to consult with an attorney of my choice, at my expense, or that I may ask the court to appoint an attorney for me. I consent to be adopted by the petitioner named above. I understand that the effect of this adoption, if it is granted, will be to terminate parental rights between me and my biological mother father and to create the legal relationship of parent and child between me and the petitioner named above. Inheritance. I understand that my right to inherit from and through my biological parents will not be affected by the adoption. Visitation. I understand that no visitation rights will be retained after the adoption. will retain the right to visitation with me after the adoption.

4. 5.

6.

7.

8.

I understand 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 I understand that my consent cannot be withdrawn after the judge signs the decree of adoption.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 follows: a. Within 10 days after I sign this form, I can deliver written notice to the court (at the address given in paragraph 8), or to the person who obtained my consent. This written notice must be delivered or postmarked by the tenth day.
AS 25.23.060-.070, .130 AS 25.24.310 Adoption Rule 9

Page 1 of 2 P-420 (4/97)(st.2) CONSENT TO STEPPARENT ADOPTION (CHILD'S CONSENT)

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 my best interests after both the petitioner and I are given notice and an opportunity to be heard.

9.

I understand that the adoption petition has been or will be filed in the Superior Court at: Court Address: Court Telephone Number:

10.

I am not a member of an Indian tribe or an Alaska Native Village. In addition, I believe that I am not eligible for such membership and that neither of my biological parents is a member of an Indian tribe or an Alaska Native Village. I acknowledge that I have received a copy of this consent (or will receive one after it is signed). I am not married. married. My spouse's name is

11.

12.

Date

Child's Signature (Signed in the presence of the court)

CERTIFICATION BY COURT I certify that the terms and consequences of the above consent to adoption were explained in detail to the minor child in a language that the child understood and that the child understood these terms and consequences and voluntarily signed the consent.

Date

Superior Court Judge/Master

Type or Print Name

Page 2 of 2 P-420 (4/97)(st.2) CONSENT TO STEPPARENT ADOPTION (CHILD'S CONSENT)

AS 25.23.060-.070, .130 AS 25.24.310 Adoption Rule 9