PROBATE COURT OF COUNTY, OHIO, JUDGEIN THE MATTER OF THE 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 .PETITIONERThe petitioner states the following:Full Name: Age Full Name: Age Place of Residence: Street AddressPost OfficeStateZip CodeDuration of residenceMarital Status: Date and Place of Marriage:Relationship of Minor to Petitioner: The petitioner has facilities and resource suitable to provide for the nurture and care of the minor and it is the desire of thepetitioner to establish the relationship of parent and child with the minor.MINOR TO BE ADOPTEDBirth 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 .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. The minor is in the permanent custody of whose address is .FORM 18.0 226PETITION FOR ADOPTION OF MINORAmended: March 1, 2017Discard all previous versions of this form American LegalNet, Inc. www.FormsWorkFlow.com CASE NO. 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 REQUIREDName: Relationship: Age, if minor Address: Consent filedName: Relationship: Age, if minor Address: Consent filed, the agency has permanentCustody of the minor filed under, , Consent filedPERSONS WHOSE CONSENT TO THE ADOPTION IS NOT REQUIREDNo person has timely registered pursuant to R.C. 3107.062 as a putative father of the minor. Attached is Ohio Department of Jobs and Family Services Form 1697.AThe consent of NameAddressRelationshipBThe consent of NameAddressRelationshipis/are not required because:ABThe 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 homeof 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. FORM 18.0 226PETITION FOR ADOPTION OF MINORPAGE 2Amended: March 1, 2017Discard all previous versions of this form American LegalNet, Inc. www.FormsWorkFlow.com CASE NO. Attorney for PetitionerPetitionerTyped or Printed NameTyped or Printed NameStreet AddressPetitionerCityState Zip CodeTyped or Printed NameTelephone Number (include area code)Street AddressAttorney Registration No. CityStateZip CodeTelephone Number (include area code)FORM 18.0 226PETITION FOR ADOPTION OF MINORPAGE 3Amended: March 1, 2017Discard all previous versions of this form American LegalNet, Inc. www.FormsWorkFlow.com