IN THE PROBATE COURT OF MAHONING COUNTY, OHIO JUDGE MARK BELINKY IN THE MATTER OF THE ADOPTION CASE NO.: _________________ OF:_________________________________ PETITION FOR RELEASE OF IDENTIFYING INFORMATION [R.C. §3107.41] The undersigned respectfully petitions the Court for the Release of Information concerning his /her adoption, as is provided by Section 3107.41 of the Revised Code of Ohio. Petitioner says that he/she was born on the ___________ day of _____________________, _____________, at (Month) (Year) ___________________________________ and believes that he/she was adopted on or about the (City and State) ______ day of ___________, _________. (Month) (Year) Petitioner further says that the Court has jurisdiction to hear this Petition based upon the following: Petitioner is a resident of Ohio, and/or Petitioner was adopted through the Probate Court of Mahoning County, Ohio Petitioner is not a resident of the State of Ohio and does not know if he/she was adopted through any Court within the State of Ohio. Petitioner further says that _______________________________________ is the Agency that (Name of Adoptive Agency) was involved in his/her adoption. Petitioner states the names of the Adoptive Parents are____________________________ _____________________________________________________________________________________ Wherefore, Petitioner hereby requests the Court to appoint an Agency and issue such Orders as may be authorized by Section 3107.41 (B) (l) of the Revised Code and, upon the receipt of the Agency’s report, to grant the relief provided in Section 3107.41 (C). Petitioner further requests that the Court Order that this petition remain pending in accordance with Section 3107.41 (E). __________________ Date _______________________________________ (Signature of Petitioner) _______________________________________ (Printed name) _______________________________________ (Address) (______)_________________________________ (Area Code / Phone) Revised 01-15-08 American LegalNet, Inc. www.FormsWorkflow.com