COURT COUNTY OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .:::::::Index No.PROBATE COURT OF MONTGOMERY COUNTY, OHIOALICE O. McCOLLUM, JUDGECalendar No.ADOPTION OFJUDICIAL SUBPOENAPlaintiff(s) -against-Defendant(s)(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 toPETITIONER The petitioner states the following:PEOPLE OF THE STATE OF NEW YORKFull Name:AgeFull Name:AgePlace of Residence:GREETINGS:Street AddressCity or Village or Township if unincorporated areaCountyWE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Court at the Honorable,Duration of residence Zip CodePost OfficeStatelocated at County ofo'clock in the day ofnoon, and at any recessed room, on the, 20, at adjourned date, to testify and give evidence as a witness in this action on the part of theMarital 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.Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply.MINOR TO BE ADOPTEDDate of Birth: Birth Name:, one of the Justices of theCourt in Witness, Honorableday of, 20 County,Place of Birth:Property and Value:The minor is living in the home of the petitioner, and was placed therein for adoption on theday ofby(Attorney must sign above and type name below)The minor is not living in the home of the petitioner, and resides atAttorney(s) forThe 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;Office and P.O. AddressA certified copy of the birth certificate of the minor is filed with this petition or is not available due to the following:Preliminary Estimate Accounting (Form 18.9), if required, is filed with this petition.Telephone No.: Facsimile No.: E-Mail Address:The minor is in the permanent custody of whose address isMobile Tel. No.:American LegalNet, Inc. www.USCourtForms.comFORM 18.0 -PETITION FOR ADOPTION OF MINOR Page 1 of 210/01/97COURT COUNTY OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .CASE NO.:::::::Index No.PERSONS OR AGENCIES WHOSE CONSENT TO THE ADOPTION IS REQUIREDCalendar No.Relationship:Age, if minor Name:JUDICIAL SUBPOENAPlaintiff(s) -against-Defendant(s)Consent filed Address:Relationship: Name:Age, if minorAddressConsent filedthe agency has permanent custody of the minor. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .filed underConsent filed Case No. Court CountyTHE PEOPLE OF THE STATE OF NEW YORK TOPERSONS 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.The consent of ANameAddressRelationshipGREETINGS:The consent of BWE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Court at the the HonorableNameAddressRelationship,is/are not required because:located at County ofA Bo'clock in the day of, on the, 20, at or adjourned date, to testify and give evidence as a witness in this action on the part of thenoon, and at any recessed in roomThe 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.Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply.State other grounds under R.C. 3107.07 (includes putative father of the minor born before January 1, 1997.), one of the Justices of theCourt in Witness, Honorableday of, 20 County,Petitioner Attorney for Petitioner(Attorney must sign above and type name below)Typed or Printed Name Typed or Printed NameAttorney(s) forPetitioner Street AddressTyped or Printed Name State CityZip CodeOffice and P.O. AddressStreet Address Phone Number (include area code)Telephone No.: Facsimile No.: E-Mail Address:Attorney Registration No.StateCityZip CodeMobile Tel. No.:Phone Number (include area code)American LegalNet, Inc. www.USCourtForms.comFORM 18.0 -PETITION FOR ADOPTION OF MINOR Page 2 of 2