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Petition Of Foreign Birth Record Form. This is a Ohio form and can be use in Lucas County (Court Of Common Pleas).
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Tags: Petition Of Foreign Birth Record, Ohio County (Court Of Common Pleas), Lucas
PROBATE COURT OF LUCAS COUNTY, OHIO
JUDGE JACK R. PUFFENBERGER
IN THE MATTER OF
THE ADOPTION OF:
____________________________________
CASE NO.
PETITION OF FOREIGN BIRTH RECORD
(R.C. 3107.18)
(Check applicable boxes, complete applicable blanks, strike inapplicable language, and attach supporting
documentation)
The Petitioner(s) is/are the adoptive parent(s) of a minor child pursuant to a foreign
decree or certificate of adoption and state that:
PETITIONER(S)
Petitioner’s Full Name:
Petitioner’s Full Name:
Residence:
Duration of Residence:
Marital Status:
Date & Place of Marriage:
ADOPTED CHILD
Name of Child Before Adoption:
Name of Child After Adoption:
Date & Place of Birth:
ATTACHED IS A CERTIFIED COPY OF THE CHILD’S BIRTH
CERTIFICATE, AND IF NOT IN ENGLISH, ALSO ATTACHED IS A
TRANSLATION CERTIFIED AS TO ITS ACCURACY BY THE
TRANSLATOR. IF A REVISED BIRTHDATE IS RECOMMENDED AN
AFFIDAVIT OF THE PHYSICIAN SHALL BE ATTACHED.
PAGE 1 OF 2 OF FORM – ADPFBR – PETITION FOR FOREIGN BIRTH RECORD
EFF. DATE 11/2008
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CASE NO.
ATTACHED IS A CERTIFIED COPY OF THE FOREIGN DECREE OR
CERTIFICATE OF ADOPTION WHICH HAS BEEN VERIFIED AND APPROVED BY
THE IMMIGRATION AND NATURALIZATION SERVICE OF THE UNITED STATES,
AND IF NOT IN ENGLISH, ALSO ATTACHED IS A TRANSLATION CERTIFIED AS
TO ITS ACCURACY BY THE TRANSLATOR. IF A REVISED BIRTHDATE IS
RECOMMENDED AN AFFIDAVIT OF THE PHYSICIAN SHALL BE ATTACHED.
Attached is a fully completed Ohio Department of Health, Division of Vital Statistics, Certificate
of Adoption Form HEA 2757 (LCPC form 20.18).
The Petitioner(s) state that giving effect to the Foreign Decree or Certificate of Adoption would
not violate the public policy of the State of Ohio and respectfully pray for the following Order(s):
An Order that the child’s name shall be changed to:
An Order that the child’s birth date shall be changed to:
An Order to the Department of Health to issue a foreign birth record for the adopted person
under R.C. 3705.12(A)(4).
____________________________________
Petitioner
____________________________________
Petitioner
____________________________________
Address
____________________________________
____________________________________
Phone Number (include area code)
____________________________________
PAGE 2 OF 2 OF FORM – ADPFBR – PETITION FOR FOREIGN BIRTH RECORD
EFF. DATE 11/2008
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www.FormsWorkflow.com