Consent To Adoption Form - Child Over 12 Years Of Age

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District Court
Denver Juvenile Court
___________________________________County, Colorado
Court Address:
IN THE MATTER OF THE PETITION OF:
_______________________________
(name of person(s) seeking to adopt)
FOR THE ADOPTION OF A CHILD
COURT USE ONLY
Attorney or Party Without Attorney (Name and Address):
Case Number:
Phone Number:
E-mail:
FAX Number:
Atty. Reg. #:
Division
Courtroom
CONSENT TO ADOPTION – CHILD OVER 12 YEARS OF AGE
1. I hereby consent to my adoption by _____________________________________ (name of party)
and waive any and all notices required by law.
2. I am ____________ years of age and my date of birth is ________________________________.
I, _________________________________, swear/affirm under oath that I have read the foregoing
Consent to Adoption – Child Over 12 Years of Age and that the statements set forth herein are true to
the best of my knowledge and belief.
Date: ___________________________
______________________________________
Adoptee
Subscribed and affirmed, or sworn to before me in the County of ________________________, State of
____________________, this _______, day of ________________, 20 _____.
My Commission Expires: ___________________
__________________________________
Notary Public/Deputy Clerk
JDF 511
R7/06
CONSENT TO ADOPTION – CHILD OVER 12 YEARS OF AGE

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