Consent To Adoption
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Consent To Adoption Form. This is a Ohio form and can be use in Lucas County (Court Of Common Pleas).
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Tags: Consent To Adoption, 20.06, Ohio County (Court Of Common Pleas), Lucas
IN THE COURT OF COMMON PLEAS OF LUCAS COUNTY, OHIO
PROBATE DIVISION
JACK R. PUFFENBERGER, JUDGE
IN THE MATTER OF THE ADOPTION OF
CASE NO. _________________________
_______________________________________
CONSENT TO ADOPTION
(Name after adoption)
[R.C. 3107.06, 3107.08 & 3107.081]
The undersigned __________________________________________________________
[check one of the following seven capacities by which your consent is given]
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Mother
Father
Putative father who has registered under R.C. 3107.062 (for a minor born on or
after January 1, 1997)
Putative father (for a minor born before January 1, 1997)
Agency having permanent custody
Minor, who is more than twelve years of age (this consent must be executed in the
presence of the Court)
Other ____________________________________________________________
hereby waives notice of the hearing on the Petition for Adoption to be filed in the Court, and
consents to the adoption of _______________________________________________________
as proposed in the petition.
(Name before adoption)
The undersigned further states that this consent is voluntarily executed irrespective of disclosure
of the name or other identification of the prospective adopting parents.
__________________________________________
Sworn to before me and signed in my presence this ___ day of ______________________ 20 __.
__________________________________________
Person authorized pursuant to R.C. Chapter 3107
To take this acknowledgement
__________________________________________
Title
LCPC Form 20.6
(18.3 – consent to adoption)
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