PROBATE COURT OF TRUMBULL COUNTY, OHIO JAMES A. FREDERICKA, JUDGE ADOPTION OF __________________________________________________________ CASE NO. _____________________ 1DPH DIWHU DGRSWLRQ PETITION FOR ADOPTION OF MINOR >5& @ 7KH XQGHUVLJQHG SHWLWLRQV WR DGRSW BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB D PLQRU DQG WR FKDQJH WKH QDPH RI WKH PLQRU WR BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB 7KH SHWLWLRQHU VWDWHV WKH IROORZLQJ PETITIONER )XOO 1DPH BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB $JH BBBBBBBBBBBBBBBB )XOO 1DPH BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB $JH BBBBBBBBBBBBBBBB 3ODFH RI 5HVLGHQFH BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB 6WUHHW $GGUHVV BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB &LW\ RU 9LOODJH RU 7RZQVKLS LI XQLQFRUSRUDWHG DUHD 3RVW 2IILFH 6WDWH &RXQW\ BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB =LS &RGH 'XUDWLRQ RI UHVLGHQFH 0DULWDO 6WDWXV BBBBBBBBBBBBBBBBBBBBBB 'DWH DQG 3ODFH RI 0DUULDJH BBBBBBBBBBBBBBBBBBBBBBBBBBBBB 5HODWLRQVKLS RI 0LQRU WR 3HWLWLRQHU BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB 7KH SHWLWLRQHU KDV IDFLOLWLHV DQG UHVRXUFHV VXLWDEOH WR SURYLGH IRU WKH QXUWXUH DQG FDUH RI WKH PLQRU DQG LW LV WKH GHVLUH RI WKH SHWLWLRQHU WR HVWDEOLVK WKH UHODWLRQVKLS RI SDUHQW DQG FKLOG ZLWK WKH PLQRU MINOR TO BE ADOPTED %LUWK 1DPH BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB 'DWH RI %LUWKBBBBBBBBBBBBBBBBBBBBBBBBBBBBB 3ODFH RI %LUWK BBBBBBBBBBBBBBBBBBBBBBBBBBBBB 3URSHUW\ DQG 9DOXH BBBBBBBBBBBBBBBBBBBBBBBBBBBB 7KH PLQRU LV OLYLQJ LQ WKH KRPH RI WKH SHWLWLRQHU DQG ZDV SODFHG WKHUHLQ IRU DGRSWLRQ RQ WKH BBBBBBB GD\ RI BBBBBBBBBBBBBBB BBBBBBB E\ BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB 7KH PLQRU LV QRW OLYLQJ LQ WKH KRPH RI WKH SHWLWLRQHU DQG UHVLGHV DWBBBBBBBBBBBBBBBBBBBBBBBBBBB BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB 7KH PLQRU ZLOO EH DQ DGRSWHG SHUVRQ DV GHILQHG LQ 5& 7KH PLQRU ZLOO EH DQ DGRSWHG SHUVRQ DV GHILQHG LQ 5& $ FHUWLILHG FRS\ RI WKH ELUWK FHUWLILFDWH RI WKH PLQRU LV ILOHG ZLWK WKLV SHWLWLRQ RU LV QRW DYDLODEOH GXH WR WKH IROORZLQJ BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB $ 3UHOLPLQDU\ (VWLPDWH $FFRXQWLQJ )RUP  LI UHTXLUHG LV ILOHG ZLWK WKLV SHWLWLRQ 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, ___________________________. ________________ Court - County Case No. Consent filed 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 B The consent of ___________________________________________________________________ Name Address Relationship The consent of ____________________________________________________________________ Name Address Relationship is/are not required because: A 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. 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 of 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.) ________________________________________________________________________________ ________________________________________________________________________________ B FORM 18.0 ­ PETITION FOR ADOPTION OF MINOR Eff. Date: January 1, 2010 American LegalNet, Inc. www.FormsWorkFlow.com CASE NO.___________________ _______________________________________ Attorney for Petitioner _______________________________________ Typed or Printed Name _______________________________________ Street Address _______________________________________ City State Zip Code _______________________________________ Phone Number (include area code) Attorney Registration No. _________________ ___________________________________________ Petitioner ___________________________________________ Typed or Printed Name ___________________________________________ Petitioner ___________________________________________ Typed or Printed Name ___________________________________________ Street Address ___________________________________________ 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