PROBATE COURT OF HAMILTON COUNTY, OHIOADOPTION 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 toPETITIONER The petitioner states the following:Age Full Name:Full Name:AgePlace of Residence:Street AddressCity or Village or Township if unincorporated areaCountyDuration of residence Zip Code Post OfficeStateMarital 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.MINOR TO BE ADOPTEDDate of Birth: Birth Name:Property and Value: Place of Birth:The minor is living in the home of the petitioner, and was placed therein for adoption on theday of,byThe minor is not living in the home of the petitioner, and resides atThe 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 filed with this petition or is not available due to the following:Preliminary Estimate Accounting (Form 18.9), if required, is filed with this petition.The minor is in the permanent custody of whose address isFORM 18.0 -PETITION FOR ADOPTION OF MINOR Page 1 of 210/1/972002 © American LegalNet, Inc.---PERSONS OR AGENCIES WHOSE CONSENT TO THE ADOPTION IS REQUIREDRelationship:Age, if minor Name:Consent filed Address:Relationship:Age, if minor Name:AddressConsent filed, the agency has permanent custody of the minorConsent filed filed under,Case No. Court CountyPERSONS WHOSE CONSENT TO THE ADOPTION IS NOT REQUIREDNo 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. The consent of AAddressRelationship NameThe consent of BAddress NameRelationship is/are not required because: A BThe 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. 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 born before January 1, 1997.)Petitioner Attorney for PetitionerTyped or Printed Name Typed or Printed NamePetitioner Street AddressTyped or Printed Name StateZip Code CityStreet Address Phone Number (include area code)Attorney Registration No.StateZip Code CityPhone Number (include area code)FORM 18.0 -PETITION FOR ADOPTION OF MINORNAME Page 2 of 22002 © American LegalNet, Inc.
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