IN THE COURT OF COMMON PLEAS OF WOOD COUNTY, OHIO PROBATE DIVISION In the Matter of * Case No. _______________________ * Judge David E. Woessner *********** FOREIGN ADOPTION R.C. 3107.18 _________________________________ and _________________________________ petition(s) the Court for the following: An order to issue a foreign birth record to be issued from the Bureau of Vital Statistics, Columbus, Ohio. A fully completed Ohio Department of Health, Division of Vital Statistics, Certificate of Adoption Form HEA 2757 is attached. A name change to _____________________________________ as indicated on the Vital Statistics, Certificate of Adoption form which is attached. A final order of adoption. (A hearing may be required for this action.) A Foreign Decree or Certificate of Adoption in compliance with the laws of the country of _____________________________ was issued for ______________________________ whose date of birth is ________________________by ______________________________________ (name of Court) on the ________ day of________________________, __________. 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. THE FOREIGN BIRTH CERTIFICATE IS ATTACHED. ALSO ATTACHED IS A TRANSLATION CERTIFIED AS TO ITS ACCURACY BY THE TRANSLATOR. ____________________________ ______________________________ Petitioner’s Signature Petitioner’s Address ____________________________ ______________________________ Petitioner’s Printed Name ____________________________ _______________________________ Petitioner’s Signature ____________________________ ________________________________ Petitioner’s Printed Name Petitioner’s Telephone Number 19.7 - Request for Foreign Birth Record 19.7E - Order to Issue Foreign Birth Record 2/28/08 American LegalNet, Inc. www.FormsWorkflow.com