CONSENT BY UNMARRIED FATHER

 

I, ________________________________________________, an unmarried man, having in my custodial care and under my maintenance _________________________ (Name of Child ), a _______ (Male/Female) child ____________(____) years of age, and having been declared to be the father thereof, by the judgment of the __________ _____________ (Court) at its __________ term, the mother of the above-named child being __________________________________, (Name) do hereby consent to the formal adoption of said child by ________________________________________ and _______________________________________, husband and wife, in accordance with the order of the _________________________ (Court), made on ___________ (Date).  The child is to be hereafter named and known as ___________________________, and to be presented to ________________________ and ___________________________, husband and wife, and duly adopted and raised as their own child.

 

In witness whereof, I have signed this instrument at ____________________________ (Place of Execution) on ____________ (Date).

 

__________________________________________

Signature of Father

 

This document was hereby signed in the presence of the following:

 

 

__________________________________________          __________________

Signature                                                                                                           Date

 

 

__________________________________________          __________________

Signature                                                                                                           Date