PROBATE COURT OF _____________ 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 _______________________________________________. PETITIONER The petitioner states the following: 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 __________________, 20______ 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 January 1, 2010 American LegalNet, Inc. www.FormsWorkFlow.com CASE NO. _______________________ □ 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 ______________________________, ____________________ □ Consent filed Court – County 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 B Address Relationship The consent of __________________________________________________________________ Name Address Relationship is/are not required because: A □ B □ □ □ 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 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.) ___________________________________________________________________ The parent has failed without justifiable cause to provide more than de minimis contact 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. ___________________________________________________________________ FORM 18.0 – PETITION FOR ADOPTION OF MINOR Eff. Date January 1, 2010 American LegalNet, Inc. www.FormsWorkFlow.com CASE NO. _______________________ __________________________________ ____________________________________ Attorney for Petitioner Petitioner __________________________________ ____________________________________ Typed or Printed Name Typed or Printed Name __________________________________ ____________________________________ Street Address Petitioner __________________________________ ____________________________________ City Typed or Printed Name State Zip Code __________________________________ ____________________________________ Phone number (include area code) Street Address Attorney Registration No. ___________________ ____________________________________ City State Zip Code ____________________________________ Phone number (include area code) FORM 18.0 – PETITION FOR ADOPTION OF MINOR Eff. Date January 1, 2010 American LegalNet, Inc. www.FormsWorkFlow.com