It is highly recommended that you have a licensed attorney review any legal documents for which you are searching in order to make sure that your needs are being properly and completely satisfied.





This certifies that the attached document, executed on ____________(Date), by _____________________________ (Name) of _____________________________ __________________________________ (Address), relinquishing custody of the child named _________________________ (Name), to _____________________________, an agency authorized to place children for adoption in a suitable home, was executed in accordance with the laws of ___________________________ (State/Commonwealth); and that the above-named child was placed for adoption with _____________________ _____________________________ (Name/Names), of _________________________ _____________________________________________ (Address), who ____________ (Has/Have) filed a petition to formally adopt the above-named child in the Court of _____________________________________________ (Name and Address of Court).


Approval is hereby granted for completion of the above-referenced adoption.


In witness whereof, I have signed this instrument in my capacity as the duly authorized representative of ________________________________________ (Agency).



________________________________________                               _____________

Signature and title of agency official                                                            Date



Printer Friendly Version