COURT COUNTY OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .:::::::Index No.Calendar No.PROBATE COURT OF STARK COUNTY, OHIO JUDICIAL SUBPOENAPlaintiff(s) -against-Defendant(s)ADOPTION(Name after adoption) CASE NO.CONSENT TO ADOPTION [R.C. 3107.06, 3107.08 & 3107.081]. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .The undersignedTHE PEOPLE OF THE STATE OF NEW YORK TO[check one of the following seven capacities by which your consent is given]MotherFatherPutative father who has registered under R.C. 3107.062 (for a minor born on or after January 1997)Putative father (for a minor born before January 1, 1997) Agency having permanent custody Minor, who is more than twelve years of age (this consent must be executed in the presence of the Court) OtherGREETINGS: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 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 theYour 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.hereby waives notice of the hearing on the Petition For Adoption to be filed in the court, and consents to the adoption of(Name before adoption) as proposed in the petition.The undersigned further states that this consent is voluntarily executed irrespective of disclosure of the name, one of the Justices of theCourt in Witness, Honorableday of, 20 County,or other identification of the prospective adopting parents.(Attorney must sign above and type name below). Sworn to before me and signed in my presence thisday ofAttorney(s) forOffice and P.O. AddressTelephone No.: Facsimile No.: E-Mail Address:Person authorized pursuant to R.C. Chapter 3107 to take this acknowledgement TitleMobile Tel. No.:FORM 18.3 -CONSENT TO ADOPTIONAmerican LegalNet, Inc. www.USCourtForms.com10/1/97
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