Form 139. Consent Of Stepparent'S Spouse (Biological Parent)
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2FORM 139. CONSENT OF STEPPARENT'S SPOUSE
(BIOLOGICAL PARENT)
STATE OF VERMONT
PROBATE COURT
DISTRICT OF ______________
Docket No. __________
IN RE ADOPTION OF __________________________________________
(a minor)
CONSENT OF STEPPARENT'S SPOUSE
(BIOLOGICAL PARENT)
15A V.S.A. § 4-404
1.
My Full Name
_____________________________________________________
2.
My Mailing Address _____________________________________________________
_____________________________________________________
_____________________________________________________
3.
My Date of Birth
_____________________________________________________
4.
Full Name of Minor Who Is Being Adopted ____________________________________
5.
Date of Birth of Minor Who Is Being Adopted __________________________________
6.
Full Name, Address and Telephone Number of the Attorney Representing the Prospective
Adoptive Parent(s) With Whom I have Placed, or Intend to Place my Minor Child for Adoption:
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
7.
I state that I have legal and physical custody of my above-named minor child. I voluntarily and
unequivocally consent to the adoption of my said minor child.
8.
I understand and agree that the adoption will not terminate the relationship of parental
relationship between my minor child and me.
9.
I understand and agree that the adoption will terminate the relationship of parent and child
between my minor child and the minor child's other parent.
10.
I understand and agree that the adoption will terminate any existing court order for custody,
visitation, or communication with the minor child.
11.
I understand and agree that notwithstanding the adoption:
A. the minor and any descendent of the minor will retains rights of inheritance from and through
the minor's other parent;
10/04 SML
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