Ad 2 - California Department Of Social Services - State Of California printable pdf download

Ad 2 - California Department Of Social Services - State Of California

STATE OF CALIFORNIA—HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES

Original for Court Record

Certified Copy for State Department of Social Services

IN THE SUPERIOR COURT OF THE STATE OF CALIFORNIA

IN AND FOR THE COUNTY OF_____________________

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In the Matter of the Petition of

STEPPARENT ADOPTION

Consent to Adoption by Parent

______________________

Petitioner

Retaining Custody

I, the undersigned, being the parent of _________________________________________________________ give my full and

Name of Minor

free consent to the adoption of said child by _________________________________________________________________ , who is

Name of Petitioner (Stepparent)

my husband/wife/domestic partner without relinquishing any of my rights, duties, obligations as his/her parent, and I respectfully ask

that the petition be granted.

Said child was born on __________________________________ in ___________________________________and is the child

Date

City and State

of __________________________________________________________and __________________________________________________________

Name of Legal Parent

Date_________________________ 20 ______

_________________________________________________

Signature of Parent

Signed in the presence of

___________________________________

*Title

* The Clerk of the Superior Court, the Probation Officer, or, where stepparent investigations are delegated to County Welfare

Departments, a County Welfare Department Staff member may witness.

This form for use only when person giving consent is husband or wife of petitioner or domestic partner, as defined in Family

Code Section 297, of petitioner.

Original for court record, certified copy to be sent immediately to California Department of Social Services, Sacramento.

AD 2 (6/02)

Ad 2 - California Department Of Social Services - State Of California