Minor Consent To Relinquishment Of Custodial Rights

Minor Consent to Relinquishment of Custodial Rights

STATE/COMMONWEALTH

COUNTY OF

, being duly sworn and deposed, hereby

swear and attest to the following:

That I am a legal minor, born on

and that my legal

guardian(s) is/are

I hereby voluntarily consent to the relinquishment of custodial rights of my legal guardian(s), and

understand that said rights will be transferred to

I understand that once this relinquishment is executed it will be permanent and irrevocable unless it was

made fraudulently or under duress. Once executed, this relinquishment will terminate all rights,

responsibilities, privileges, obligations, and duties associated with care, support, visitation, custody,

inheritance, and notice of adoption between me and my legal guardian(s).

Signature:

Date:

This document was acknowledged before me on

[Notary Seal, if any]:

(Signature of Notarial Officer)

Notary Public for the State/Commonwealth of

My commission expires

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Parent category: Legal