Free District Court Denver Juvenile Court ___________________________________County, ... - Colorado

District Court Denver Juvenile Court ___________________________________County, Colorado Court Address: IN THE MATTER OF THE PETITION OF: _______________________________ FOR THE ADOPTION OF A CHILD Attorney or Party Without Attorney (Name and Address):
(name of person(s) seeking to adopt)

COURT USE ONLY Case Number:

Phone Number: FAX Number:

E-mail: Atty. Reg. #:

Division

Courtroom

CONSENT TO ADOPTION ­ CHILD OVER 12 YEARS OF AGE 1. I hereby consent to my adoption by _____________________________________ (name of party) and waive any and all notices required by law. 2. I am ____________ years of age and my date of birth is ________________________________.

I, _________________________________, swear/affirm under oath that I have read the foregoing Consent to Adoption ­ Child Over 12 Years of Age and that the statements set forth herein are true to the best of my knowledge and belief.

Date: ___________________________

______________________________________ Adoptee

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 511

R7/06

CONSENT TO ADOPTION ­ CHILD OVER 12 YEARS OF AGE