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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 VII. Surrogate's Court Forms |
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Subchapter B. Adoption Forms of the Surrogate's Court |
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Adoption Forms |
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2-Ga Extrajudicial consent (birth or legal parent - private-placement - step-parent) |
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D.R.L. §§ 115, 115-b(8) Form 2-Ga (Extrajudicial Consent Birth or Legal Parent - Private-Placement Step-parent) 12/97 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 EXTRAJUDICIAL CONSENT (Birth or Legal Parent - Private-Placement- Step-parent) ________________ 1. I, , residing at , am the (birth) (legal) parent of . I do hereby consent to the adoption of my (daughter)(son) , born on by[specify name]: , adoptive parent. 2. the name and last known address of the other (birth)(legal) parent of the adoptive child are: Dated: ______ / (Birth)(Legal) parent: typed or printed name/signature / Adoptive Parent: typed or printed name/signature / Adoptive Parent: typed or printed name/signature / Adoptive child if over 18: typed or printed name/signature / Attorney if any: typed or printed name/signature Attorney's Address and Telephone number Form 2-ga page 2 STATE OF NEW YORK ) : ss.: COUNTY OF ) On this day of 19 , , the person who executed the foregoing instrument, personally came before me and acknowledged that (he) (she) executed the same. Notary Public |