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Supplemental Adoption Information 4472 - Ohio
| Supplemental Adoption Information Form. This is a Ohio form and can be used in Adoption Probate Cuyahoga County (Court Of Common Pleas) . |
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SUPPLEMENTAL ADOPTION INFORMATION FULL NAME: Petitioner FULL NAME: Spouse (INCLUDE MAIDEN NAME IN PARENTHESIS) ADDRESS: CITY: STATE: ZIP CODE: PHONE: DURATION OF RESIDENCE IN CUYAHOGA COUNTY: Mr. Mrs. MR.S PLACE OF EMPLOYMENT: (NAME) ADDRESS: PHONE: MRS.S PLACE OF EMPLOYMENT: (NAME) ADDRESS: PHONE: DATE AND PLACE OF BIRTH OF MR.: AGE: MR.S RACE: NATIONALITY: EDUCATION: RELIGION: DATE AND PLACE OF BIRTH OF MRS.: AGE: MRS.S RACE: NATIONALITY: EDUCATION: RELIGION: DATE AND PLACE OF MARRIAGE: MARRIAGE VERIFIED IS THIS THE FIRST MARRIAGE? (for each): LIST PREVIOUS MARRIAGES AND DIVORCES: RELATIONSHIP TO PERSON(S) BEING ADOPTED: LIST OTHER CHILDREN AND THEIR BIRTH DATES: HAVE YOU EVER BEEN IN THE SERVICE?: MR. MRS. TYPE OF DISCHARGE: VERIFIED: HAVE YOU EVER BEEN ARRESTED OR CONVICTED OF AN OFFENSE AGAINST THE LAW O R ARE YOU NOW UNDER ANY CHARGES FOR ANY OFFENSE AGAINST THE LAW? (Include Court- Martial in Military Service.) MR. MRS. 4472 (Continued on Other Side) American LegalNet, Inc. www.USCourtForms.com <<<<<<<<<********>>>>>>>>>>>>> 2HAVE EITHER OF YOU BEEN TO AN ADOPTION AGENCY? HAVE YOU EVER BEEN TURNED DOWN BY AN ADOPTION AGENCY? DO YOU HAVE A HISTORY OF DRUG OR ALCOHOL ABUSE? DO YOU HAVE A HISTORY OF MENTAL ILLNESS? MR. MRS. IF YES, EXPLAIN HAVE YOU HAD ANY CONTACT WITH A PSYCHOLOGIST, PSYCHIATRIST, OR SOCIAL WO RKER IN REGARDS TO YOUR MARITAL, EMOTIONAL, OR PERSONAL PROBLEMS? MR. MRS. IF YES, EXPLAIN WE CERTIFY THAT ALL OF THE ANSWERS MADE IN THIS STATEMENT ARE TRUE AND COMPLETE AND CORRECT TO THE BEST OF OUR KNOWLEDGE AND BELIEF. Signature -Husband Signature Wife DATE SIGNED American LegalNet, Inc. www.USCourtForms.com
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