P 415 Form – Fill Out and Use This PDF

IN THE SUPERIOR COURT FOR THE STATE OF ALASKA

AT

In the matter of the adoption of					)
					)
					)
					)
				,	)
		(child's name after adoption)			)
DOB:			, A Minor Child,		)
					)
By				,	) CASE NO.
			Petitioner.		)
					) CONSENT TO STEPPARENT ADOPTION
					(FROM PARENT GIVING UP CHILD)

2.I understand that prior to signing this consent I have the right to consult with an attorney of my choice, at my expense. I also understand that if I refuse to sign the consent and the petitioner proceeds with the adoption, I may be eligible for a court-appointed attorney.

3.I consent to the adoption of the above-named child by the petitioner.

4.I understand that by signing this consent, I am giving up all my rights to the care, custody and control of the child, and that I am giving up these rights permanently. I will also be permanently relieved of all responsibility for the child after the decree of adoption is signed. Except as stated in paragraphs 5 and 6 below concerning inheritance and visitation rights, I will no longer have any legal relationship to the child.

5.Inheritance. The petitioner's spouse and I are the biological parents of the child. Therefore, the child's right to inherit from and through me is not affected by the adoption. AS 13.12.114(b).

6.Visitation.

I do not want to keep any visitation rights after the adoption is granted.

I request that the court grant

me

my relative

visitation with the child in the discretion of the petitioner and petitioner's spouse, according to the best interests of the child.

I request that the court grant

me

my relative

the following visitation with the child: (Describe visitation agreement, including times, places, who pays for transportation, etc.)

7.I understand I have a limited right to withdraw my consent. I understand that my consent cannot be withdrawn after the judge signs the decree of adoption. However, before the adoption decree is signed, I can withdraw my consent as follows:

Page 1 of 2
P-415 (5/12)(cs)	AS 25.23.060-.070
CONSENT TO STEPPARENT ADOPTION (FROM PARENT GIVING UP CHILD)	Adoption Rule 9

a.Within 10 days after I sign this form, I can deliver written notice to the court at the address in paragraph 8 or to the person who obtained my consent. This written notice must be delivered or postmarked by the tenth day.

b.After the above 10-day period, if the decree has not been signed, I can file a request to withdraw with the court, which the court may or may not grant. My request will be granted only if the court finds that it is in the best interests of the child after both the petitioner and I are given notice and an opportunity to be heard.

8.I understand that the adoption petition will be filed in the Superior Court at: Court Address:

Court Telephone Number:

9.The child is not a member of an Indian tribe or an Alaska Native Village. In addition, the child is not eligible for such membership, and neither of the child's biological parents is a member of an Indian tribe or an Alaska Native Village.

11.I acknowledge that I have received a copy of this consent (or will receive one after it is signed).

12.I understand that by signing this consent I am waiving my right to notice of the date and time of the adoption hearing. I understand I can obtain this information by contacting the court.

I state on oath or affirm that I have read this consent form and believe all statements made in it are true. I am signing this consent freely and voluntarily.

		Date				Signature of Parent Giving Consent
							Mailing Address
					City			State	Zip
							Daytime Phone
				ACKNOWLEDGEMENT & OATH
On			,					personally appeared
		(date)		(name)
before me in						, Alaska,	signed the above consent		to

adoption, certified under oath or affirmation that he/she has read it and believes its contents to be true, and acknowledged that he/she signed the consent freely and voluntarily for the purposes stated therein.

(SEAL)

Clerk of Court, Notary Public or other person authorized to administer oaths.

My commission expires:

Page 2 of 2
P-415 (5/12)(cs)	AS 25.23.060-.070
CONSENT TO STEPPARENT ADOPTION (FROM PARENT GIVING UP CHILD)	Adoption Rule 9