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WRITTEN CONSENT PURSUANT TO M. G. L. c. 210, § 2 ...

I, as the of , age , ofthe sex, born in , on ,do hereby voluntarily and unconditionally surrender to thecare and custody of for the purpose of adoption orsuch other disposition as may be made by a court of competent jurisdiction. I waive notice of anylegal proceeding affecting the custody, guardianship, adoption or other disposition of.

do hereby voluntarily and unconditionally surrender to the care and custody of for the purpose of adoption or such other disposition as may be made by a court of competent jurisdiction.

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  Consent, Surrender, Written, Pursuant, Written consent pursuant to m

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Transcription of WRITTEN CONSENT PURSUANT TO M. G. L. c. 210, § 2 ...

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