Form 2-Ga "Extrajudicial Consent (Birth or Legal Parent - Private-Placement - Step-Parent)" - New York

Form 2-Ga or the "Extrajudicial Consent (birth Or Legal Parent - Private-placement - Step-parent)" is a form issued by the New York State Unified Court System.

Download a fillable PDF version of the Form 2-Ga down below or find it on the New York State Unified Court System Forms website.

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Download Form 2-Ga "Extrajudicial Consent (Birth or Legal Parent - Private-Placement - Step-Parent)" - New York

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D.R.L. §§ 115, 115-b(8)
Form 2-Ga
(Extrajudicial Consent
Birth or Legal Parent -
Private-Placement
Step-parent)
8/2002
SURROGATE’S COURT OF THE STATE OF NEW YORK
COUNTY OF ____________________________
____________________________________________
In the Matter of the Adoption of
(Docket)(File) No.
A Child whose First Name is
_________________________
________________________________________
EXTRAJUDICIAL CONSENT
(Birth or Legal Parent -
Private-Placement -
Step-parent)
____________________________________________
1. I, _____________________, residing at_________________________________________
______________ , am the (birth) (legal) parent of ___________________. I do hereby consent to the
adoption of my (daughter) (son) ________________________________________________________
_________________________, born on _________________________________________
by [specify name]:__________________ , adoptive parent.
2. The name and last known address of the other (birth)(legal) parent of the adoptive child are
[delete if inapplicable]:_______________________________________________________________
Dated:________,_____.
______________________________/_____________________________________
(Birth)(Legal) Parent: typed or printed name/ signature
_____________________________________/________________________________
Attorney if any: typed or printed name/signature
______________________________________________________________________
Attorney’s Address and Telephone number
STATE OF NEW YORK
)
:ss:
COUNTY OF ____________)
On [specify date]:___________________ , [specify name]:_____________________________
personally appeared before me. (He)(She) is personally known to me or proved (his)(her) identity to
me by satisfactory evidence as the person whose name is subscribed on this extrajudicial surrender.
(He)(She) acknowledged to me that (he)(she) executed this surrender.
____________________________
Notary Public
D.R.L. §§ 115, 115-b(8)
Form 2-Ga
(Extrajudicial Consent
Birth or Legal Parent -
Private-Placement
Step-parent)
8/2002
SURROGATE’S COURT OF THE STATE OF NEW YORK
COUNTY OF ____________________________
____________________________________________
In the Matter of the Adoption of
(Docket)(File) No.
A Child whose First Name is
_________________________
________________________________________
EXTRAJUDICIAL CONSENT
(Birth or Legal Parent -
Private-Placement -
Step-parent)
____________________________________________
1. I, _____________________, residing at_________________________________________
______________ , am the (birth) (legal) parent of ___________________. I do hereby consent to the
adoption of my (daughter) (son) ________________________________________________________
_________________________, born on _________________________________________
by [specify name]:__________________ , adoptive parent.
2. The name and last known address of the other (birth)(legal) parent of the adoptive child are
[delete if inapplicable]:_______________________________________________________________
Dated:________,_____.
______________________________/_____________________________________
(Birth)(Legal) Parent: typed or printed name/ signature
_____________________________________/________________________________
Attorney if any: typed or printed name/signature
______________________________________________________________________
Attorney’s Address and Telephone number
STATE OF NEW YORK
)
:ss:
COUNTY OF ____________)
On [specify date]:___________________ , [specify name]:_____________________________
personally appeared before me. (He)(She) is personally known to me or proved (his)(her) identity to
me by satisfactory evidence as the person whose name is subscribed on this extrajudicial surrender.
(He)(She) acknowledged to me that (he)(she) executed this surrender.
____________________________
Notary Public
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