Form Ad 887 - Statement Of Understanding - Parent Who Gave Physical Custody Of The Child To The Petitioner(S) Page 6

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SECTION B
Complete if signed outside of California*
***THIS FORM MUST BE SIGNED BY A NOTARY PUBLIC WHEN SIGNED OUTSIDE OF CALIFORNIA***
The Notary Public must staple the Acknowledgement document to this form and sign and date below.
SIGNATURE OF NOTARY
DATE
*If signing outside the United States this section must meet with the requirements of California Civil Code
Section 1183
SECTION C
Complete if signed outside of California in the Armed Forces (Do not complete Section B)
Signed (pursuant to California Civil Code Section 1183.5) in the presence of:
On this the____________ day of _____________, 20_______ before me, ___________________________________ ,
NAME OF OFFICER
the undersigned officer, personally appeared ___________________________________ known to me (or satisfactorily
NAME OF CONSENTING PARENT
proven) to be:
1) Serving in the armed forces of the United States,
2) A spouse of a person serving in the armed forces of the United States, or
3) A person serving with, employed by, or accompanying the armed forces of the United States outside the United
States and outside of the Canal Zone, Puerto Rico, Guam, and the Virgin Islands.
The parent is also known me (or satisfactorily proven) to be the person whose name is subscribed to the within
instrument and acknowledged that he or she executed the same. I certify that at the date of this certificate, I am a
commissioned officer of the armed forces of the United States having the general powers of a notary public under the
provisions of Section 936 or 1044a of Title 10 of the United States Code (Public Law 90-632 and 101-510).
Subscribed and sworn to before me on this ______________ day of __________________, 20_______.
SIGNATURE OF OFFICER
RANK AND SERIAL NUMBER
BRANCH OF SERVICE
CAPACITY IN WHICH SIGNED
AD 887 (5/17) Parent Who Gave Physical Custody (Custodial Parent) of the Child to the Petitioner(s)
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