2-D Consent of child over 14 (private-placement), Adoption Forms, Subchapter B. Adoption Forms of the Family Court, Chapter IV. Forms of the Family Court of the State of New York and Adoption Forms of the Family Court of the State of New York (cf. s205.7), Subtitle D. Forms, TITLE 22. Judiciary, New York Codes Rules Regulations

New York Codes Rules Regulations (Last Updated: March 27,2024)

Chapter IV. Forms of the Family Court of the State of New York and Adoption Forms of the Family Court of the State of New York (cf. s205.7)

Subchapter B. Adoption Forms of the Family Court

Adoption Forms

2-D Consent of child over 14 (private-placement)

D.R.L.§ 111(1)(a)

Form 2-D

(Consent of Child-

Private-Placement)

8/2002

COURT OF THE STATE OF NEW YORK

COUNTY OF

________________

In the Matter of the Adoption of A Child Whose First Name Is

(Docket) (File) No.

CONSENT OF CHILD

OVER 14

(Private-Placement)

________________

The undersigned adoptive child, who is years old, having been born on

, hereby consents to (his)(her) adoption by

), the petitioning adoptive parent(s) in the above-entitled proceeding.

Dated:

Child

Adoptive Parent: typed or printed name/signature

Adoptive child if over 14: typed or printed name/signature

Attorney if any: typed or printed name/signature

Attorney's Address and Telephone number

Form 2-D Page 2

STATE OF NEW YORK

)

) ss.:

COUNTY OF

)

On [specify date]:

, [specify name]:

personally appeared before me. (He)(She) is personally known to me or proved (his)(her) identity to me by satisfactory evidence as the person whose name is subscribed on this consent. (He)(She) acknowledged to me that (he)(she) executed this consent.

Notary Public

STATE OF NEW YORK

)

) ss.:

COUNTY OF

)

On this

day of

, , before me personally came

proven to me by the oath of

attorney admitted to practice in the State of New York to be the person described in and who executed the foregoing instrument and

duly acknowledged that executed the same.

______________

Judge of the Court