FORM 107.01-15 Consent to Accept Custody
|
IN
RE: |
) |
TERM,
|
|
ADOPTION
OF: __________________ |
) |
(year)
|
|
) |
NO.
|
CONSENT TO ACCEPT CUSTODY
TO THE HONORABLE, THE JUDGES OF THE SAID COURT:
__________________ and __________________, neŽe
__________________, being duly sworn according to law, depose and say:
1. That your deponents are husband and wife and reside at __________________,
where they have resided continuously since __________________ (date ).
2. That, on __________________ (date ), they
received custody of __________________ from __________________.
3. That they consent to accept custody of the said child.
________________________
Petitioner
________________________
Petitioner
(Verification)