PROBATE COURT OF IN THE MATTER OF THE ADOPTION OF (Name after adoption) COUNTY, OHIO 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 , at and that all necessary proceedings relative to an adoption were complied with; and the Court on the by and the minor's name is changed to in the records of the Court. day of , decreed that the minor is legally adopted WITNESS my signature and seal of said Court, this day of , Probate Judge By: Deputy Clerk FORM 18.8 - ADOPTION CERTIFICATE FOR PARENTS 10/1/97 American LegalNet, Inc. www.FormsWorkflow.com