PROBATE COURT OF TRUMBULL COUNTY, OHIO JAMES A. FREDERICKA, JUDGE IN THE MATTER OF THE ADOPTION OF _______________________________________________ (Name after adoption) CASE NO. ____________________ ADOPTION CERTIFICATE FOR PARENTS This is to certify, that in an action pending in this Court, on a petition filed by _______________________ __________________________________________________________________________________________ to adopt ___________________________________________________________________________________ a minor, satisfactory evidence was submitted to prove, and the Court found, that the minor was born on the _________ day of _______________________________, 20_____, at _________________________________ and that all necessary proceedings relative to an adoption were complied with; and the Court on the ___________ day of _______________________________, 20_____, decreed that the minor is legally adopted by _______________________________________________________________________________________ and the minor's name is changed to ____________________________________________________________ in the records of the Court. WITNESS my signature and seal of said Court, this _____ day of _______________________, 20______ _______________________________________________ James A. Fredericka, Probate Judge By: ____________________________________________ Deputy Clerk 18.8 - ADOPTION CERTIFICATE FOR PARENTS 10/1/97 American LegalNet, Inc. www.USCourtForms.com