AOC-292 |
Doc. Code: AWCA |
|
|
|
|
LT H |
OF |
|
|
Case No. |
__________________ |
|
|
|
|
|
|
|
|
Rev. 6-19 |
|
|
|
|
EA |
K |
|
|
|
|
|
W |
|
|
|
|
|
|
|
|
|
E |
|
|
|
M |
O |
N |
|
|
N |
|
|
|
|
|
T |
|
|
|
|
M |
|
|
|
|
U |
|
|
|
Page 1 of 2 |
|
|
|
|
|
|
|
C |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
O |
|
|
|
|
l e x |
K |
|
q District |
q Family |
|
C |
|
|
|
|
Y |
Court |
|
|
|
|
|
|
e t |
|
|
|
|
|
|
|
|
j u s t i t i a |
|
Commonwealth of Kentucky |
C |
|
|
|
|
E |
O |
|
|
IC |
|
|
|
|
|
U |
|
|
|
|
|
|
|
|
|
RT |
O F |
ST |
|
|
|
|
|
|
|
|
|
|
JU |
|
|
County |
__________________ |
Court of Justice |
www.courts.ky.gov |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
KRS 625.041(3); 199.011(17); and |
APPEARANCE WAIVER AND |
Division |
__________________ |
199.500 |
|
CONSENT TO ADOPTION |
|
|
|
IN THE INTEREST OF:
_____________________________________________, a child
Respondent
_______________________________________________
Address
_______________________________________________
_______________________________________________
WAIVER OF APPEARANCE
I, ___________________________________________________________, hereby state that I am the natural parent of
the above-named child and I hereby voluntarily, and with full knowledge and agreement, waive my right to appear in the
above-styled proceeding to terminate my parental rights.
_______________________________________________
Parent's Signature
_______________________________________________
Parent's Name (please print)
_______________________________________________
Counsel for Parent
_______________________________________________
Guardian ad litem for Minor Parent
_______________________________________________
Cabinet Designee
SUBSCRIBED AND SWORN TO before me this ________ day of __________________________, 2________
My Commission Expires: _________________________ |
____________________________________________ |
|
Notary/Clerk |
|
By: ____________________________________, D.C. |
q
Please mail a copy of the FINAL JUDGMENT to:
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
AOC-292 |
|
Rev. 6-19 |
CONSENT TO ADOPTION |
Page 2 of 2 |
|
I, ______________________________________________, hereby state that I am the natural q mother q
father of
(parent's name)
_______________________________________________, the child to be adopted, who was born to me q in wedlock
(child's name)
q
out-of-wedlock on __________________ in ________________________________________________________.
(child's date of birth) |
(city, state, country of child's birth) |
I also state, and acknowledge by my initials, that:
_____ I do not desire to know the identification of the proposed adoptive parent(s) of my child; or
_____ The proposed adoptive parent of my child is:______________________________________________.
_____ I understand that if the adoption is not adjudged, that the disposition of my child will be made pursuant to KRS 199.550.
_____ The total amount of my legal fees related to the execution of this consent are $___________________ to be paid
by _______________________________________.
_____ That I have reviewed this consent and the legal effect of this consent has been fully explained to me.
_____ That I have not been coerced in any way to execute this consent, nor have I been given or promised anything of
value, except those expenses allowable under KRS 199.590(6), to execute this consent.
_____ That it is my intention to consent to the adoption of my child.
I understand that this consent to the adoption of my child will become final and irrevocable seventy-two (72) hours after the execution of this consent and that this consent may be withdrawn only by written notification sent to the proposed
adoptive parent or the attorney for the proposed adoptive parent on or before the expiration of the seventy-two (72) hours by certified or registered mail and also by first class mail.
I hereby acknowledge, by my signature, executed this ______ day of _________________________, 2______ in
___________________________, __________________________ County, Kentucky at __________ q a.m. q p.m.
that I have voluntarily and knowingly given my informed consent to the adoption of my child.
|
____________________________________________ |
|
Consenting Parent's Signature |
|
SUBSCRIBED AND SWORN TO before me this ________ day of __________________________, 2________ |
My Commission Expires: _________________________ |
____________________________________________ |
|
Notary/Clerk |
By: ____________________________________, D.C.
Preparer's Name & Address
__________________________________________
__________________________________________
__________________________________________
Reviewer's Name & Address
__________________________________________
__________________________________________
__________________________________________
I received a completed and signed copy of this consent on the same day I signed it.
|
____________________________________________ |
|
Consenting Parent's Signature |
|
SUBSCRIBED AND SWORN TO before me this ________ day of __________________________, 2________ |
My Commission Expires: _________________________ |
____________________________________________ |
|
Notary/Clerk |
By: ____________________________________, D.C.