CONSENT TO ADOPTION OF ADULT OR
EMANCIPATED M
I
NO
R
BY SPOUSE OR PARTNER
15A V.S A. §5-103
I swear or affirm under oath that the facts set forth below are true and I consent to the adoption of the person
named below.
My Information:
My Name: _________________________________________ Date of Birth: _____________________________
Address: __________________________________________ Email Address: ____________________________
City/State/Zip: _____________________________________ Daytime Phone: ___________________________
Name of Attorney: ____________________________________________________________________________
Address of Attorney: _________________________________ City/State/Zip: ____________________________
Information about the Adult or Emancipated Minor:
Adoptee’s Name: __________________________________ Date of Birth: _____________________________
Name(s) of the Prospective Adoptive Parents:
____________________________________________ _____________________________________
(Check One Box Only)
☐ The prospective adoptive parent and I are married. The date of our marriage is: _______________
☐ The prospective adoptive parent and I are partners. We have been partners since: _____________
I understand the consequences the adoption may have for any right of inheritance, property, or support I
have.
