PROBATE COURT OF LUCAS COUNTY, OHIO JACK R. PUFFENBERGER, JUDGE IN THE MATTER OF THE ADOPTION OF: (Name after Adoption) CASE NO. ________________ PETITION FOR ADULT ADOPTION The undersigned respectfully petitions the court for permission to adopt ________________________________________ an adult and to have the adult’s name changed to ____________________________________________________. Petitioner says he/she may adopt the adult because the adult is totally and permanently disabled. is determined to be a mentally retarded person. had established a child-foster parent or child-stepparent relationship with the petitioner as a minor. ____________________________________ Attorney for Petitioner ____________________________________ Typed or Printed Name ____________________________________ Address ____________________________________ ____________________________________ Petitioner ____________________________________ Typed or Printed Name ____________________________________ Address ____________________________________ ____________________________________ Phone Number (include area code) ____________________________________ Phone Number (include area code) Attorney Registration Number ENTRY This cause is set for hearing on the ___ day of ________________, 20___ at _____ o’clock ___. m. ______________________________ Judge Jack R. Puffenberger 19.0 Petition for Adoption of Adult American LegalNet, Inc. www.FormsWorkFlow.com