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New York Codes Rules Regulations (Last Updated: March 27,2024) |
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TITLE 22. Judiciary |
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Subtitle D. Forms |
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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) |
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Subchapter B. Adoption Forms of the Family Court |
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Adoption Forms |
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2-B Agreement of adoption (private-placement) |
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D.R.L. §§ 111(1)(f), 115(4) Form 2-B (Agreement of Adoption Private-Placement) 8/2002 COURT OF THE STATE OF NEW YORK COUNTY OF ________________ In the Matter of the Adoption of (Docket) (File) No. A Child whose First Name is AGREEMENT OF ADOPTION (Private-Placement) ________________ The undersigned petitioning adoptive parent(s) hereby agree(s) to adopt the above-named adoptive child and to treat said child in all respects as (his) (her) (their) own lawful child and to extend and assure to said child all the rights, benefits and privileges incident to such relationship, and to incur and fulfill all the responsibilities of (a) parent(s) with respect to said child. Dated: / Adoptive Parent: typed or printed name/signature / 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-B Page 2 STATE OF NEW YORK ) ss: COUNTY ) 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 agreement of adoption and consent. (He)(She) acknowledged to me that (he)(she) executed this agreement of adoption and consent. Notary Public STATE OF NEW YORK ) ss: COUNTY ) 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 agreement of adoption and consent. (He)(She) acknowledged to me that (he)(she) executed this agreement of adoption and consent. Notary Public STATE OF NEW YORK ) ss: COUNTY ) On this day of , , proven to me by the oath of , an attorney admitted to practice in the State of New York, to be the person(s) who executed the foregoing instrument, personally came before me and acknowledged that (he)(she) executed the same. ______________ Judge of the Court |