PROBATE COURT OF MONTGOMERY COUNTY, OHIO 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. FORM 18.0 – PETITION FOR ADOPTION OF MINOR Eff. Date March 1, 2008 American LegalNet, Inc. www.FormsWorkflow.com The minor is in the permanent custody of ___________________________________________________ whose address is _________________________________________________________________________. The guardian ad litem during the permanent custody proceedings was _____________________________ whose address is _________________________________________________________________________. 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: ___________________________________________________________ Consent filed Name: _________________________ Relationship: ___________________ Age, if minor _______ Address :__________________________________________________________ Consent filed _____________________________________________________, the agency has permanent custody of the minor filed under , ___________________________. ________________ Court - County Consent filed Case No. 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 to communicate with the minor 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. 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.) ________________________________________________________________________________ ________________________________________________________________________________ 2 FORM 18.0 – PETITION FOR ADOPTION OF MINOR Eff. Date March 1, 2008 American LegalNet, Inc. www.FormsWorkflow.com _______________________________________ 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) 3 FORM 18.0 – PETITION FOR ADOPTION OF MINOR Eff. Date March 1, 2008 American LegalNet, Inc. www.FormsWorkflow.com