PROBATE COURT OF STARK COUNTY, OHIO DIXIE PARK, JUDGE ADOPTION OF (Name after adoption) CASE NO. PETITION TO RECOGNIZE FOREIGN ADOPTION [R.C. 3107.18] [Check applicable boxes, complete blanks, strike inapplicable language, and attach supporting documentation] The Petitioner(s) is/are the adoptive parent(s) of a minor child pursuant to a Foreign Decree or Certificate of Adoption and state that: PETITIONER(S) Petitioner's Full Name:___________________________________________________________________________ Petitioner's Full Name:___________________________________________________________________________ Residence: ____________________________________________________________________________________ Duration of Residence: ____________________________________________________________________________ Marital Status: ___________________________________________________________________________________ Date and Place of Marriage: ________________________________________________________________________ ADOPTED CHILD Name of Child before Adoption: ___________________________________________________________________ Name of Child after Adoption: _____________________________________________________________________ Date and Place of Birth: _________________________________________________________________________ Attached is a certified copy of the child's Birth Certificate, and if not in English, also attached is a translation certified as to its accuracy by the translator. A Foreign Decree or Certificate of Adoption in complianc with the laws of the Country of _______________________ was issued by (Name of Court) ________________________________ in Case Number _______________________ on the ______ day of __________________, 20___. FORM 19.2 - PETITION TO RECOGNIZE FOREIGN ADOPTION American LegalNet, Inc. www.FormsWorkFlow.com CASE NO. Attached is a certified copy of the Foreign Decree or Certificate of Adoption which has been verified and approved by the Immigration and Naturalization Service of the United States, and if not in English, also attached is a translation certified as to its accuracy by the translator. Attached is a fully completed Ohio Department of Health, Division of Vital Statistics, Certificate of Adoption. The Petitioner(s) state that giving effect to the Foreign Decree or Certificate of Adoption would not violate the public policy of the State of Ohio and respectfully pray for the following Order(s): An Order that the child's name shall be changed to: ______________________________________________________________________________________ An order to the Ohio Department of Health to issue a new birth record for the adopted person under R.C. 3705.12(A)(1) Other _________________________________________________________________________________ Attorney for Petitioner Typed or Printed Name Street Address City State Zip Code Petitioner Typed or Printed Name Petitioner Typed or Printed Name Street Address Phone Number (include area code) City Attorney Registration No. Phone Number (include area code) State Zip Code American LegalNet, Inc. www.FormsWorkFlow.com