Free District Court Denver Juvenile Court __________________________________County, C... - Colorado

District Court Denver Juvenile Court __________________________________County, Colorado Court Address:

IN THE MATTER OF THE PETITION OF: ______________________________ (name of person(s) seeking to adopt) FOR THE ADOPTION OF A CHILD Attorney or Party Without Attorney (Name and Address): COURT USE ONLY Case Number:

Phone Number: FAX Number:

E-mail: Atty. Reg. #:

Division

Courtroom

CONSENT TO ADOPTION ­ CUSTODIAL PARENT 1. I certify that I am the birth father mother of ________________________________ (name of child) and I certify that the Respondent is the birth father mother of said child. 2. I certify that I am consenting to the adoption of the child by the above-named Petitioner(s). I, __________________________________, swear/affirm under oath that I have read the foregoing Consent to Adoption - Custodial Parent and that the statements set forth herein are true to the best of my knowledge and belief.

___________________________________
Signature of

Father

Mother

Subscribed and affirmed, or sworn to before me in the County of ________________________, State of ____________________, this _______, day of ________________, 20 _____. My Commission Expires: ___________________ ______________________________________ Notary Public/Deputy Clerk

JDF 509 R7/06

CONSENT TO ADOPTION ­ CUSTODIAL PARENT