PROBATE COURT OF WOOD COUNTY, OHIO David E. Woessner, Judge In the Matter of the ADOPTION of:_____________________________________________________ (Name after adoption) Case No. _____________________________ Date:_______________________ AFFIDAVIT OF ADOPTED PERSON I, _________________________________, being first duly sworn, say that my name after the adoption (Adopted Person's Present Name) proceeding was _________________________________ and that I was born on _______________________ (Adoptive Name) (Date of Birth) in ____________________________________. (Place of Birth: City and State) Check appropriate box: I have personally appeared and presented two items of identificationš to the clerk at the time of filing the Petition. or I have included a copy of two items of identification with my Petition. ________________________________ Signature of Adopted Person Sworn before me and signed in my presence this ______ day of ____________________, 20 ____. ________________________________ Notary Signature ________________________________ Notary's Printed Name ________________________________ Date Commission Expires SEAL šAs per R.C. 3107.38(A)(2), items of identification include a motor vehicle driver's or commercial driver's license, an identification card issued under R.C. 4507.50 to 4507.52, a marriage application, a Social Security card, a credit card, a military identification card, or an employee identification card. One item of identification must contain a picture. 40.1 Affidavit of Adopted Person American LegalNet, Inc. www.FormsWorkFlow.com