COURT COUNTY OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .:::::::Index No.PROBATE COURT OF HAMILTON COUNTY, OHIOJAMES CISSELL, JUDGECalendar No.JUDICIAL SUBPOENAPLACEMENT OFPlaintiff(s) -against-Defendant(s)(Name before placement) CASE NO.PRE -PLACEMENT APPLICATIONThe undersigned, being husband and wife, hereby make application to be approved for placement of a child for purposes of adoption pursuant to Section 5103.16(D) of the Ohio Revised Code, and state the following facts. Husband's name: 1.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .THE PEOPLE OF THE STATE OF NEW YORKLastFirstMiddleWife's name: 2.LastFirstMiddleGREETINGS:Residence address: 3.WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Court at the HonorableStreet,located at County ofCityState Countyo'clock in the day ofnoon, and at any recessed room, on the, 20, at adjourned date, to testify and give evidence as a witness in this action on the part of theExpected birth date of infant: 4.Wherefore, your applicant(s) pray that the Court make an investigation concerning themselves and the information contained in this Application, for which authority is hereby given, and to approve them as proposed adopting parents for placement of a child by virtue of Ohio Revised Code Section 5103.16(D)Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to 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., one of the Justices of theCourt in Witness, Honorableday of, 20 County,Husband Attorney for Prospective Adoptive Parents(Attorney must sign above and type name below)Typed or Printed NameTyped or Printed NameAttorney(s) forAdd ressWifeTyped or Printed NameOffice and P.O. AddressPhone Number (include area code)Phone Number (include area code)Telephone No.: Facsimile No.: E-Mail Address:Attorney Registration NumberMobile Tel. No.:American LegalNet, Inc. www.USCourtForms.com02/10/03H.C. FORM 118.20 -PRE -PLACEMENT APPLICATION
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