PROBATE COURT OF HAMILTON COUNTY, OHIO JAMES CISSELL, JUDGE 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 of the minor to_____________________________________________________________. The petitioner states the following: PETITIONER Full Name:___________________________________________________________________________ Age______________ Full Name:___________________________________________________________________________ Age______________ Place of Residence:___________________________________________________________________________________ Street Address __________________________________________________________________________________________________________________________ City or Village or Township if unincorporated area County __________________________________________________________________________________________________________________________ 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 resources suitable to provide for the nurture and care of the minor and it is the desire of the 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:_____________________________ † The minor is living in the home of the petitioner, and was placed therein for adoption on the _________ day of ____________, ______ by ______________________________________________________________________ † The minor is not living in the home of the petitioner, and resides at_________________________________________ ____________________________________________________________________________________________ † † The minor will be an adopted person as defined in R.C. 3107.39; The minor will be an adopted person as defined in R.C. 3107.45; A certified copy of the birth certificate of the minor is filed with this petition or is not available due to the following: ___________________________________________________________________________________________________ A Preliminary Estimate Accounting (Form 18.9), if required, is filed with this petition. Page 1 of 3 FORM 18.0 - PETITION FOR ADOPTION OF MINOR  American LegalNet, Inc. www.FormsWorkFlow.com CASE NO. ____________________ F The minor is in the permanent custody of__________________________________________________________________ whose address is_________________________________________________________________________________. F The guardian ad litem during the permanent custody proceedings was ______________________________________ whose address is _______________________________________________________________________________. F The attorney representing the minor during the permanent custody proceedings was ___________________________ ______________________________________________________________________________________________. whose address is _______________________________________________________________________________ PERSONS OR AGENCIES WHOSE CONSENT TO THE ADOPTION IS REQUIRED † Name: __________________________________________ Relationship:___________________Age, if minor____ Address:______________________________________________________________________ † Name: __________________________________________ Relationship:___________________Age, if minor____ Address :______________________________________________________________________ † † Consent filed † Consent filed ____________________________________________________, the agency has permanent custody of the minor filed under __________________________________, _________________________________. Court - County Case No. † Consent filed PERSONS WHOSE CONSENT TO THE ADOPTION IS NOT REQUIRED † No person has timely registered pursuant to R.C. 3107.062 as a putative father of the minor born on or after January 1, 1997. Attached is Ohio Department of Human Services Form 1697. A The consent of________________________________________________________________________________ Name Address Relationship B The consent of________________________________________________________________________________ Name Address Relationship is/are not required because: A B † † The parent has failed without justifiable cause WR SURYLGH PRUH WKDQ GH PLQLPLV FRQWDFW with the minor for a period of †† †† DW OHDVW RQH \HDU immediately preceding the filing of the adoption petition or placement of the minor in the home RI WKH petitioner. 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. State other grounds under R.C. 3107.07 (includes putative father of the minor born before January 1, 1997.) ____________________________________________________________________________________________ ____________________________________________________________________________________________ Page 2 of 3 FORM 18.0 – PETITION FOR ADOPTION OF MINOR  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) ________________________________________________ Street Address Attorney Registration No. _________________________ ______________________________________________ City State Zip Code ________________________________________________ Phone Number (include area code) Page 3 of 3 FORM 18.0 – PETITION FOR ADOPTION OF MINOR  American LegalNet, Inc. www.FormsWorkFlow.com