THE WOOD COUNTY PROBATE COURT JUDGE DAVID E. WOESSNER Request for Copies of Adoption Documents Adoptions Finalized After January 1, 1964 through September 17, 1996 Pursuant to Ohio Revised Code 3107.41 This form is to request copies of documents contained in an adoption file for an adoption finalized between January 1, 1964 and September 17, 1996. This information will not contain identifying information. This form must be accurately and completely filled out prior to the Court releasing any documents. Requests for identifying information must be pursuant to Ohio Revised Code Section 3107.41. The release of information shall be only upon the filing of the Petition for Release. Requests made other than in person to the Court, shall require the additional filing of Form AR17AB. The release of any information contained in an adoption file is subject to the discretion of the Probate Court and may be denied. Name: Mr. □ Mrs. □ Ms. □ Address: City: State: Home Telephone: ( Postal Code ) Date of Birth: Name of Child at time of Adoption: Party to the Adoption: □ Adopted Person □ Parent of Adopted Minor Date Adoption Finalized or Date on Final Decree (if known): Court where Adoption Finalized: Please Check the Appropriate Box to Indicate the Type of Information Requested: □ Final Decree and Adoption Certificate - $7.00 □ Social and Medical History – No Charge □ Petition for the Release of Information - $25.00 Please Attach Form 40.0 AR41 American LegalNet, Inc. www.FormsWorkflow.com Approval of the Court The Court hereby approves the foregoing release of information is in compliance with Ohio Revised Code Section 3107.17 and 3107.41. ____________________________________ Date ________________________________ Judge David E. Woessner AR41 S:\FORMS\Word Templates\AR41-1964-1996.doc American LegalNet, Inc. www.FormsWorkflow.com