COURT COUNTY OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .:::::::ERIEPROBATE COURT OF COUNTY, OHIOIndex No.Calendar No.IN THE MATTER OF THE ADOPTION OF(Name after adoption)JUDICIAL SUBPOENACASE NO.Plaintiff(s) -against-Defendant(s)PETITION FOR ADOPTION OF MINOR [R.C. 3107.05]R.C. 3107.05The undersigned petitions to adopt a minor, and to change the name of the minor to The petitioner states the following:. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .PETITIONERTHE PEOPLE OF THE STATE OF NEW YORK TOFull Name:AgeFull Name:AgePlace of Residence:Street AddressGREETINGS:City or Village or Township if unincorporated areaCountyWE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Court at the the Honorable,Post OfficeStatezip CodeDuration of residencelocated at County ofo'clock in the day of, on the, 20, at or adjourned date, to testify and give evidence as a witness in this action on the part of thenoon, and at any recessed in roomMarital Status:Date and Place of Marriage:Relationship of Minor to Petitioner: The petitioner has facilities and resources 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.Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply.MINOR TO BE ADOPTEDBirth Name:Date of Birth:, one of the Justices of theCourt in Witness, Honorableday of, 20 County,Place of Birth:Property and Value:The minor is living in the home of the petitioner, and was placed therein for adoption on theday of(Attorney must sign above and type name below)byThe minor is not living in the home of the petitioner, and resides atAttorney(s) forR.C. 3107.39 R.C. 3107.45Office and P.O. AddressTelephone No.: Facsimile No.: E-Mail Address:The minor will be an adopted person as defined in R.C. 3107.39; The minor will be an adopted person as defined in R.C. 3107.45; A certified copy of the birth certificate of the minor is attached (if not available attach an explanation). A Preliminary Estimate Accounting (Form 18.9), if required, is attached. The minor is in the permanent custody of whose address isMobile Tel. No.:18.0 PETITION FOR ADOPTION OF MINOR PERSONS OR AGENCIES WHOSE CONSENT TO THE ADOPTION IS REQUIREDAmerican LegalNet, Inc. www.USCourtForms.comCOURT COUNTY OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .PERSONS OR AGENCIES WHOSE CONSENT TO THE ADOPTION IS REQUIRED:::::::Index No.Name:Relationship:Age, if minorCalendar No.Address:Consent filedJUDICIAL SUBPOENAPlaintiff(s) -against-Defendant(s)Name:Relationship:Age, if minorAddress:Consent filed, the agency has permanent custody of the minorfiled underConsent filed Court CountyCase No.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .PERSONS WHOSE CONSENT TO THE ADOPTION IS NOT REQUIREDR.C. 3107.062THE PEOPLE OF THE STATE OF NEW YORK TONo person has timely registered pursuant to R.C. 3107.062 as a putative father of the minor born on or after January 1, 1997. Attached is Ohio Department of Human Services Form 1697. AThe consent ofNameAddressRelationshipBThe consent ofNameAddressRelationshipGREETINGS:is/are not required because: A B The parent has failed without justifiable cause to communicate 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.WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Court at the the Honorable,located at County ofo'clock in the day of, on the, 20, at or adjourned date, to testify and give evidence as a witness in this action on the part of thenoon, and at any recessed in roomThe 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 born before January 1, 1997.)Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply.R.C.3107.07, one of the Justices of theCourt in Witness, Honorableday of, 20 County,Attorney for PetitionerPetitioner(Attorney must sign above and type name below)Typed or Printed NameTyped or Printed NameAttorney(s) forStreet AddressPetitionerCityStateTyped or Printed NameZip CodeOffice and P.O. AddressPhone Number (include area code)Street AddressTelephone No.: Facsimile No.: E-Mail Address:Attorney Registration No.Zip CodeStateCityMobile Tel. No.:Phone Number (include area code)American LegalNet, Inc. www.USCourtForms.comForm 18.0 -Page 2
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