PROBATE COURT OF BUTLER COUNTY, OHIO IN THE MATTER OF THE ADOPTION OF (Name after adoption) CASE NO. APPLICATION FOR APPOINTMENT OF ASSESSOR [R.C. 3107.012, 3107.031] Now comes Petitioner(s) , , and request(s) that the Court appoint an assessor to perform the services required to be performed by an assessor as set forth in Chapter 3107. Petitioner(s) request(s) that the Court appoint as the assessor in this case and represents to the Court that said person or agency is duly licensed as an assessor in accordance with the requirements of Section 3107.012 of the Revised Code. Petitioner(s) understand(s) that the cost of the assessor services will be the sole responsibility of the Petitioner(s) and will contract directly with the assessor regarding payment for such services, subject to the provisions of section 3107.10 of the Revised Code. Attorney for Petitioner Petitioner Typed or Printed Name Typed or Printed Name Street Address Petitioner City State Phone Number (include area code) Zip Code Typed or Printed Name Street Address Attorney Registration No. City State Zip Code Phone Number (include area code) BCPC FORM 318 - APPLICATION FOR APPOINTMENT OF ASSESSOR 3/98 2001 © American LegalNet, Inc.