PROBATE COURT OF _____________________ COUNTY, OHIO _______________, JUDGE IN 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 ___________________________________________________________. PETITIONER The petitioner states the following: Full Name:___________________________________________________________________ Age ___________________ Full Name:___________________________________________________________________ Age ___________________ Place of Residence: __________________________________________________________________________________ Street Address __________________________________________________________________________________________________ Post Office State Zip Code Duration of residence Marital 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 the petitioner to establish the relationship of parent and child with the minor. MINOR TO BE ADOPTED Birth Name:_______________________________________ Place of Birth:_____________________________________ Date 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 ­ PETITION FOR ADOPTION OF MINOR Amended: March 1, 2017 Discard 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 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, ________________________, ___________ 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. Attached is Ohio Department of Jobs and Family Services Form 1697. A B The consent of _______________________________________________________________________ Name Address Relationship The consent of _______________________________________________________________________ Name Address Relationship is/are not required because: A B 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. __________________________________________________________________________ __________________________________________________________________________ FORM 18.0 ­ PETITION FOR ADOPTION OF MINOR PAGE 2 Amended: March 1, 2017 Discard all previous versions of this form American LegalNet, Inc. www.FormsWorkFlow.com CASE NO. __________ _________________________________________ Attorney for Petitioner _________________________________________ Typed or Printed Name _________________________________________ Street Address _________________________________________ City State Zip Code _________________________________________ Telephone Number (include area code) Attorney Registration No. ____________________ _____________________________________________ Petitioner _____________________________________________ Typed or Printed Name _____________________________________________ Petitioner _____________________________________________ Typed or Printed Name _____________________________________________ Street Address _____________________________________________ City State Zip Code _____________________________________________ Telephone Number (include area code) FORM 18.0 ­ PETITION FOR ADOPTION OF MINOR PAGE 3 Amended: March 1, 2017 Discard all previous versions of this form American LegalNet, Inc. www.FormsWorkFlow.com