Consent by Unmarried Father



I, _________________________________, an unmarried man, having in my custodial care _________________________ (Name of Child ), a _______ (Male/Female) child ____________(____) years of age, and having been declared (His/Her) father, by the judgment of the ___________________ (Court), do consent to the formal adoption of said child by ________________________________ and ____________________________________, husband and wife, in accordance with the order of______________________ (Court), made on ___________ (Date).

In witness whereof, I have signed this instrument at ____________________________ (Place of Execution) on ____________ (Date).

__________________________________________

Signature of Father

This document was signed in the presence of the following:

_____________________________ __________________

Signature Date

 

 _____________________________ __________________

Signature Date