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Application For Search Of Ohio Putative Father Registry 1695 - Ohio
| Application For Search Of Ohio Putative Father Registry Form. This is a Ohio form and can be used in Adoption Probate Cuyahoga County (Court Of Common Pleas) . |
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ODHS 1695 (9/96) Page 1 of 2 Ohio Putative Father Registry 30 E. Broad Street, Floor 31 Columbus, Ohio 43266-0423 APPLIATION FOR SEARCH OF OHIO PUTATIVE FATHER REGISTRY Please perform a search of the Ohio Putative Father Registry. Please ad vise if a Putative Father Registration Form is on file with respect to the child, mother, or father identified below: IDENTIFYING INFORMATION ABOUT THE CHILD: Childs Childs Childs LAST NAME FIRST NAME MIDDLE NAME Childs CHECK ONE o MALE RACE Childs Sex o FEMALE Childs Date of Birth Nickname or other Enter as MM/DD/YY Known names of child Estimated Due Date of Mother Enter as MONTH/YEAR o YES Certificate of Childs Place of Birth Birth o NO Hospital Name, if any Multiple o YES Birth o NO City State IDENTIFYING INFORMATION ABOUT THE MOTHER: Mothers Mothers Mothers LAST NAME FIRST NAME MIDDLE NAME Other names by which Mother may be known Mothers Address/Apt. City State Zip Mothers Mailing Address/Apt. (If different) City State Zip Mothers Phone Number ( ) Area Code Mothers Previous Address in last year. Attach extra sheet if needed. City State Zip Mothers SOCIAL SECURITY Mothers Date of Birth Mothers Number: Enter as MM/DD/YY Race DHS 1695 (6/96) American LegalNet, Inc. www.USCourtForms.com <<<<<<<<<********>>>>>>>>>>>>> 2 ODHS 1695 (9/96) Page 2 of 2 IDENTIFYING INFORMATION ABOUT THE FATHER: Fathers Fathers Fathers LAST NAME FIRST NAME MIDDLE NAME Other names by which Father may be known Fathers Address/Apt. City State Zip Fathers Mailing Address/Apt. (If different) City State Zip Fathers Phone Number ( ) Area Code Fathers Previous Address/Apt. in last year. Attach extra sheet if needed. City State Zip Fathers SOCIAL SECURITY Fathers Date of Birth Fathers Number: Enter as MM/DD/YY Race INFORMATION ABOUT INTERESTED PARTY REQUESTING SEARCH OF PUTATIVE FATHER REGISTRY: Name of Person(s) Phone Number Where Requesting Search you can be reached Firm or Agency Name FAX Number Where (if any) you can be reached Address for Notice of Search Results City State Zip Person Requesting Search is: I certify that the information provided in this Search Request Form is t rue and correct to the 5 Mother of Child best of my knowledge. I further certify that I am requesting this searc h of the Putative Father 5 Child Welfare Agency Registry to determine whether a putative father is registered in relatio n to the child referenced above, who is or may be the subject of an adoption petition, and the information obtained will 5 Attorney representing Mother of Child be used for this purpose only. 5 Attorney representing Signature of Person Child Welfare Agency Requesting Search: TO BE COMPLETED BY THE OHIO PUTATIVE FATHER REGISTRY: Date Request Received By Enter as MM/DD/YY Date of Search Request Search Request Enter as MM/DD/YY Record Locator Date Search Performed By Enter as MM/DD/YY CHECK Outcome: If Registered Registration Record Registered (Name of Father) Locator DHS 1695 (9/96) American LegalNet, Inc. www.USCourtForms.com
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