PROBATE COURT OF SHELBY COUNTY, OHIO IN THE MATTER OF THE ADOPTION OF __________________________________ (Name after adoption) Case No. _______________________ PETITION FOR ADOPTION OF ADULT [R.C. 3107.02] The undersigned respectfully petitions the Court for permission to adopt , an adult, and to have the adult's name changed to Petitioner says he/she may adopt the adult because the adult . ( ) is totally and permanently disabled. ( ) is determined to be a mentally retarded person as defined in section 5123.01 of the Revised Code. ( ) had established a child-foster caregiver or child-stepparent relationship with the petitioner as a minor, and the adult consents to the adoption. ( ) was, at that the time of the adult's eighteenth birthday, in the permanent custody of a public children services agency or a private child placing agency, and the adult consents to the adoption, and ( ) verification from the agency is attached. ______________________________ Attorney for Petitioner ________________________________ Petitioner ______________________________ Typed or Printed Address ________________________________ Typed or Printed Address ______________________________ Address ________________________________ Address ______________________________ Attorney Registration No. ______________________________ Telephone Number ______________________________ Telephone Number 19.0 - PETITION FOR ADOPTION OF ADULT American LegalNet, Inc. www.FormsWorkflow.com Page 2 Case No. _____________________ ENTRY This cause is set for hearing on the , 20 at day of o'clock .m. ________________________________ Probate Judge 19.0 - PETITION FOR ADOPTION OF ADULT American LegalNet, Inc. www.FormsWorkflow.com