Consent of children's home or agency. Consent of _________ society to the adoption of _________ by _________ and _________. The _________ society shows to the court that it is a corporation under the laws of the state of _________[duly licensed under the laws of the state of _________ as a child receiving and placing institution]; that it has read the petition of _________ and _________ for the adoption of the child _________, to which this consent is attached, and consents to the adoption prayed for. The _________ society further shows to the court that _________ was on or about the _________ day of _________, _________[date], duly and lawfully placed in the custody of the _________ society by _________, and the child is still in the control and custody of _________ society and the society is the duly and lawfully appointed guardian of the child; that according to the best information obtainable by the _________ society this child was born on or about the _________ day of _________, _________[date]; that the names of the parents of the child are _________ and _________. The _________ society further shows that on or about the _________ day of _________, _________[date], after a careful investigation of the character of the home of the petitioners, did place the child, _________, in the temporary custody and control of petitioners on trial, and the child has been in the home of the petitioners from that date under the occasional supervision and inspection of the _________ society, and the conditions in petitioner's home are favorable and in the judgment of the _________ society the petition for the adoption of the child should be granted. [Signature] State of _________ County of _________ I, _________, depose and say that I am the _________[title of officer, such as "superintendent of the _________ society"], that I have read the foregoing consent and know its contents, and that the statements contained in the consent are true. I further depose and say that I am duly authorized by the act of the board of directors of the _________ society to grant the foregoing consent. [Signature] Subscribed and sworn to, etc.