Free PC-681 - Connecticut

AGREEMENT OF ADOPTION PC-681 REV.10/00

STATE OF CONNECTICUT COURT OF PROBATE [Type or print in black ink. File in duplicate.]

RECORDED(CONFIDENTIAL VOLUME):

TO: COURT OF PROBATE, DISTRICT OF IN THE MATTER OF [Give first name only.] A MINOR CHILD, BORN ON PRESENTLY RESIDING AT: TOWN: COUNTY: PERSON GIVING MINOR CHILD IN ADOPTION C.G.S. §45a-724 Parent of minor child Parent of minor child Guardian of the person of minor child: Name: Statutory parent [Name and address of local office]

DISTRICT NO.

STATE: COMPLETE ONE ONLY of of

ADOPTING PARENT(S)

Residing at

,Connecticut 06

The PERSON GIVING THE MINOR CHILD IN ADOPTION, being a person who may give a child in adoption as by statute is provided, does give in adoption the MINOR CHILD named above to the ADOPTING PARENT(S), and the ADOPTING PARENT(S) do hereby adopt and receive said MINOR CHILD as their legal child.

The PERSON GIVING THE MINOR CHILD IN ADOPTION and the ADOPTING PARENT(S) represent that each is lawfully entitled to enter into this agreement of adoption. The PERSON GIVING THE MINOR CHILD IN ADOPTION, being a parent of said MINOR CHILD, in no way relinquishes any parental right in and to said MINOR CHILD. The name of said MINOR CHILD shall be changed to:

This agreement shall take effect upon its approval by the Court of Probate for the District of

PERSON GIVING MINOR CHILD IN ADOPTION ............................................................................. Signature Print Name: ............................................................................. Signature Print Name:

ADOPTING PARENT(S) .......................................................................... Signature Print Name: .......................................................................... Signature Print Name:

by its Dated at: ,Connecticut, on [Month, Day, Year]

MINOR CHILD'S CONSENT TO ADOPTION [USE ONLY IF MINOR CHILD IS TWELVE YEARS OF AGE OR OLDER. C.G.S. §45a-724.] I hereby consent to the above-written Agreement of Adoption.

SIGNED............................................................................................... Print Name: AGREEMENT OF ADOPTION PC-681

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