PROBATE COURT OF HAMILTON COUNTY, OHIO RALPH WINKLER, JUDGE PLACEMENT OF (Name before placement) CASE NO. APPLICATION FOR APPROVAL OF PLACEMENT Now comes (mother) (father) and legal parent of day of Said applicant states that he is at years of age and not under any disability. , and represents that he is the who was born on the Applicant proposes to place said child in the home of and , who are husband and wife, and whose address is:. for the purpose of having them adopt said child. Wherefore, your applicant prays the Court to set a day for hearing on said proposed placement and that said placement be approved in accordance with law. Witness Applicant Typed or Printed Name Address Phone Number (include area code) H.C. FORM 118.30 - APPLICATION FOR APPROVAL OF PLACEMENT American LegalNet, Inc. www.FormsWorkFlow.com 02/10/03