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PROBATE COURT OF LUCAS COUNTY, OHIO JACK R. PUFFENBERGER, JUDGE IN THE MATTER OF THE ADOPTION OF (Name after adoption) CASE NO. PETITION FOR ADOPTION OF ADULT [R.C. 3107.02] The undersigned respectfully petitions the court for permission to adopt an adult and to have the adult's name changed to The Petitioner may adopt because the adult: is totally and permanently disabled. is determined to be a person with an intellectual disability. had established a child-foster caregiver, kinship caregiver, or child-stepparent relationship with the petitioner as a minor. was, at the time of the adult's eighteenth birthday, in the permanent custody of or in a planned permanent living arrangement with a public children services agency or a private child placing agency is the child of the spouse of the petitioner . Attorney for Petitioner Petitioner Typed or Printed Name Typed or Printed Name Address Address City State Zip Code City State Zip Code Telephone Number (include area code) Attorney Registration No. Telephone Number (include area code) ENTRY at This cause is set for hearing on the o'clock .m. day of , 20 Judge Jack R. Puffenberger FORM 19.0 - PETITION FOR ADOPTION OF ADULT American LegalNet, Inc. www.FormsWorkFlow.com Amended: March 1, 2017 Discard all previous versions of this form