PROBATE COURT OF STARK COUNTY, OHIO DIXIE PARK, JUDGE IN THE MATTER OF THE ADOPTION _________________________________________________ (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 ______________________________________________. The Petitioner may adopt the adult because the adult: is totally and permanently disabled. is determined to be a person with an intellectual disability had established a child-foster caregiver, kinship caregiver, or child-stepparent relationship with the petitioner as a minor. was, at the time of the adult's eighteenth birthday, in the permanent custody of or in a planned permanent living arrangement with a public children services agency or a private child placing agency. is the child of the spouse of the petitioner. _______________________________________ Attorney for Petitioner _______________________________________ Typed or Printed Name _______________________________________ Address _______________________________________ City State Zip Code ________________________________________ Petitioner ________________________________________ Typed or Printed Name ________________________________________ Address ________________________________________ City State Zip Code _______________________________________ ________________________________________ Phone Number (include area code) Phone Number (include area code) Attorney Registration No. _______________________ ENTRY This cause is set for hearing on the __________ day of ___________________________, 20____ at ______________________ o'clock ___.m. _____________________________________________ DIXIE PARK, PROBATE JUDGE FORM 19.0 - PETITION FOR ADOPTION OF ADULT American LegalNet, Inc. www.FormsWorkFlow.com Amended: March 1, 2017 Discard all previous versions of this form