PROBATE COURT OF SHELBY COUNTY, OHIO IN THE MATTER OF THE PLACEMENT OF _________________________________ (Current Name of Child) CASE NO. ___________________________ ENTRY ON PLACEMENT This day ________________________________________________as a duly licensed assessor under the provision of section 3107.012 of the Revised Code, having made an independent home study of the proposed placement of ________________________________________________, and having filed said home study with this Court; and The Court finding said independent home study to be in order and complete, and the Court having heard the evidence upon the application for approval of placement: It is now the order of the Court that said placement is hereby approved as of record; and It is further ordered that _____________________________________________________________, as prospective adoptive parents, are granted temporary custody of _____________________________________________pending further proceedings of adoption of said child. ENTER ______________________________________________ Date ________________________________________________ Probate Judge ______________________________________________ Attorney ______________________________________________ (Type or Print Attorney's Name) ______________________________________________ Street ______________________________________________ City, State, Zip Code ______________________________________________ Telephone Number (Include area code) SCPC FORM 306 ­ ENTRY ON PLACEMENT American LegalNet, Inc. www.FormsWorkFlow.com