PROBATE COURT OF _ _ _ _ _ _ COUNTY, OHIO _ _ _ _ _ _, JUDGE IN THE MATTER OF THE ADOPTION OF _ _ _----::-:-_-:::----:--:--:-_ _ _ _ _ _ __ (Name after adoption) CASE NO. _ _ _ _ _ _ _ __ PETITION FOR ADOPTION OF MINOR [R.C.3107.05] The undersigned petitions to adopt _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ a minor, and to change the name ofthe minor to _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ PETITIONER The petitioner states the following: Full Name: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Age _ _ _ _ _ _ __ Full Name: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Age _ _ _ _ _ _ __ Place of Residence: - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Street Address Post Office State Zip Code Duration of residence Marital Status: _ _ _ _ _ _ _ _ _ _ _ _ _ Date and Place of Marriage: ______________ Relationship of Minor to Petitioner: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ The petitioner has facilities and resource suitable to provide for the nurture and care of the minor and it is the desire ofthe petitioner to establish the relationship of parent and child with the minor. MINOR TO BE ADOPTED Birth Name: -------------------------------- Date of Birth: ------------ Place of Birth: Property and Value: _ _ _ _ _ _ _ _ __ oThe minor is living in the home by _ _ _ _ _and _ _placed therein_ _adoption on the _ _ _ _ __ of the petitioner, was for day of _ ____ ________ DThe minor is not living in the home of the petitioner, and resides at _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ A certified copy ofthe birth certificate of the minor is filed with this petition or is not available due to the f01l0wing: FORM 18.0 PETITION FOR ADOPTION OF MINOR Amended: March 1,2017 Discard all previous versions of this form American LegalNet, Inc. www.FormsWorkFlow.com CASE NO. _ _ _ _ _ _ __ A Preliminary Estimate Accounting (Form 18.9), ifrequired, is filed with this petition. DThe minor is in the permanent custody whoseaddressis _____________________________________________________________ DThe guardian ad litem during the permanent custody proceedings was ________________________ whose address is DThe attorney representing the minor during the permanent custody proceedings was whose address is -------------------------------------------- ---------------------------------------------------------------- PERSONS OR AGENCIES WHOSE CONSENT TO THE ADOPTION IS REQUIRED o Name: _____________________ Relationship: _ _ _ _ _ _ _ _ Age, if minor _____ Address: 0 0 Consent filed o o Name: ________.____________ Relationship: _ _ _ _ _ _ _ _ Age, if minor ________ Address: Consent filed _______________________________________________, the agency has permanent custody of the minor filed under, ______________________ o Consent filed PERSONS WHOSE CONSENT TO THE ADOPTION IS NOT REQUIRED o A B No person has timely registered pursuant to R.C. 3107.062 as a putative father of the minor. Attached is Ohio Department of Jobs & Family Services Form 1697. The consent of ---------------------------------------------------Address Relationship Name Name Address Theconsentof _____________________________________________________ Relationship is/are not required because: o A B The parent has failed without justifiable cause to provide more than de minimis contact with the minor for a period of at least one year immediately preceding the filing of the adoption petition or the placement of the minor in the home of the petitioner. 0 The parent has failed without justifiable cause to provide for the maintenance and support of the minor as required by law or judicial decree for a period of at least one year immediately preceding the filing of the adoption petition or the placement of the minor in the home of the petitioner. 0 State other grounds under R.C. 3107.07 (includes putative father of the minor). 0 o o FORM 18.0 PETITION FOR ADOPTION OF MINOR PAGE 2 Amended: Marcb 1,2017 Discard all previous versions of tbis form American LegalNet, Inc. www.FormsWorkFlow.com CASE NO. _ _ _ _ _ _ _ __ Attorney for Petitioner Petitioner Typed or Printed Name Typed or Printed Name Street Address Petitioner City State Zip Code Typed or Printed Name Phone Number (include area code) Attorney Registration No. _ _ _ _ _ _ _ _ __ Street Address City State Zip Code Phone Number (include area code) FORM 18.0 - PETITION FOR ADOPTION OF MINOR PAGE3 Amended: March 1,2017 Discard all previous versions of this form American LegalNet, Inc. www.FormsWorkFlow.com