Form 139b. Consent Of Guardian Or Agency In Stepparent Adoption Page 2
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2Form 139B
Page 2
A. the minor and any descendant of the minor will retain rights of inheritance from and
through the parent of the minor who is not living with the stepparent; and
B. a court order for visitation or communication with the minor by either parent, or by a
person related to the minor through either parent, or an agreement or order concerning another
person which is approved by the court under 15A V.S.A. § 4-112, survives the decree of
adoption, but failure to comply with the terms of the order or agreement is not a ground for
revoking or setting aside this consent or the adoption;
C. the parent who is not living with the stepparent remains liable for arrearages of child
support unless relieved of that obligation by the parent who lives with the stepparent, and any
guardian ad litem of the minor and by a governmental agency providing public assistance to
the minor.
12.
I do one of the following:
_____ I waive notice to me or to my agency of any further proceedings in the adoption of
the minor child unless the adoption is contested, appealed, or denied.
_____ I do not waive notice to me or to my agency of any further proceedings in the
adoption of the minor child.
13.
I state for myself or on behalf of my agency that I voluntarily and unequivocally consent to
the adoption of the said minor child.
14.
I swear that the factual information set forth in this consent is true and correct to the best of
my knowledge and belief.
Dated this ____ day of ___________, 20___ at ______________________ in the County of
_____________________ and State of _______________________.
____________________________________________
(signature)
____________________________________________
(printed name)
____________________________________________
(Agency name, if applicable)
Signed and confirmed in the presence of the Judge or in the presence of a person directed by
the Judge.
____________________________________________
(signature)
____________________________________________
(printed name)
____________________________________________
(title)
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