COURT COUNTY OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .:::::::Index No.PROBATE COURT OF HAMILTON COUNTY, OHIOCalendar No.JAMES CISSELL, JUDGEJUDICIAL SUBPOENAPlaintiff(s) -against-Defendant(s)PLACEMENT OF(Name before placement)CASE NO.AFFIDAVIT REGARDING BIRTH FATHER. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .The following statements are made to the best of my knowledge regarding the child for which approval of placement for adoption is sought in the within case. [Check and complete whichever of the following are applicable]:THE PEOPLE OF THE STATE OF NEW YORK TOI have not filed proceedings under Sections 3111.01 to 3111.19 of the Ohio Revised Code or any administrative proceedings pursuant to Sections 3111.20 to 3111.29 of the Ohio Revised Code against any male person at any time before the placement of the child in the home of the adoptive parents. [ ]GREETINGS:WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Court at the the Honorable,No male person has acknowledged the paternity of the child in any court of competent jurisdiction or in any administrative proceeding. [ ]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 roomNo male person has signed the birth certificate as an informant as provided in Section 3705.14 of the Ohio Revised Code. [ ]The identity of the father is unknown. [ ]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.The father is [ ]whose residence address is, one of the Justices of theCourt in Witness, Honorableday of, 20 County,The putative father is [ ]whose residence address is(Attorney must sign above and type name below)Birth MotherAttorney(s) forday ofSworn to before me and signed in my presence this in.,Office and P.O. AddressTelephone No.: Facsimile No.: E-Mail Address:Notary PublicMobile Tel. No.:H.C. FORM 118.22 -AFFIDAVIT REGARDING BIRTH FATHER02/10/03American LegalNet, Inc. www.USCourtForms.com
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