Ohio > County (Court Of Common Pleas) > Lucas > Probate > Adoption
Application For Search Of Ohio Putative Father Registry - Ohio
| Application For Search Of Ohio Putative Father Registry Form. This is a Ohio form and can be used in Adoption Probate Lucas County (Court Of Common Pleas) . |
|
||||||
 Get this form for FREE as a print-only pdf |
|||||||
|
Ohio Department of Job and Family Services Ohio Putative Father Registry rd 255 E. Main Street, 3 Floor Columbus, Ohio 43215-5222 Phone: 1-888-313-3100 APPLICATION FOR SEARCH OF OHI O PUTATIVE FATHER REGISTRY Please perform a search of the Ohio Putative Father Registry. Please advise if a Ptative Father Registration u Form is on file with respect to the mother, child, or father identified below. IDENTIFYING INFON RMATIOABOUT THE MOTHER: Mothers LAST Name ___________________________ FIRST Name ___________________________ MIDDLE Name _______________ Social Security Number ______________________________ Phone Number (000/000/0000) ______________________ Date of Birth (MM/DD/YY) ____________________________ Race ____________________________________________ Other names by which mother may be known: Address Street Number ________________________ Street Name __________________________________________________ City _________________________________________ State ___________________________________ Zip _________________ Mothers Mailing Address/Apt. (If different than above) Street Number ________________________________ Street Name_______________ ________ _______________ ____________ City _________________________________________ State ___________________________________ Zip _________________ IDENTIFYING INFON RMATIOABOUT THE FATHER: Fathers LAST Name ___________________________ FIRST Name ___________________________ MIDDLE Name _______________ Social Security Number ______________________________ Phone Number (000/000/0000) ______________________ Date of Birth (MM/DD/YY) ____________________________ Race ____________________________________________ Other names by whichfather may be known: Address Street Number ________________________ Street Name __________________________________________________ City _________________________________________ State ___________________________________ Zip _________________ Fathers Mailing Address/Apt. (If different than above) Street Number ________________________________ Street Name_______________ ________ _______________ ____________ City _________________________________________ State ___________________________________ Zip _________________ JFS 01695 (REV. 9/2003) LCPC APPLICATION FOR SEARCH OF OHIO PUTATIVE FATHER REGISTRY PAGE 1 OF 2 American LegalNet, Inc. www.USCourtForms.com<<<<<<<<<********>>>>>>>>>>>>> 2IDENTIFYING INFORMATION ABOUT THE CHILD: Childs LAST Name ___________________________ FIRST Name ___________________________ MIDDLE Name _______________ SEXX Male Race _________________________________ CHECK ONE X Female Date of Birth )MM/DD/YY) ___________________________ Estimated Due Date of Mother )MM/YY) __________________ Childs Birthplace City _______________________________________________ State _________________________________________________ Hospital Name, if any: ________________________________________________________________________________________ X Birth Cer tified X Father Certified By State X Multiple Birth INFORMATION ABOUT INTERESTED PA RTY REQUESTING SEARCH OF PUTATIVE FATHER REGISTRY: If Firm or Agency, Name _____________________________________________________________________________________ Name of Person(s) Requesting Search ___________________________________________________________________________ Phone Number (Enter as 000/000/0000) ____________________ Fax Number (Enter as 000/000/0000) ____________________ Person Requesting Search is: X Mother of Child X Child Welfa re Agency X Attorne y Representing Mother of Child X Attorney Representing Child Welfare Agency X Att orney Arranging Adoption of Minor Address for Notice of Search Results Street Number ________________________________ Street Name_______________ ________ _______________ ____________ City _________________________________________ State ___________________________________ Zip _________________ I certify that the information provided in the Search Request Form is true and correct to the best of my knowledge. I furthertifer cy that I am requesting this search of the Putative Father Registry to determine whether a putative father is registered in relation to the child referenced above, who is or may be the subject of an adoption petition, and the information obetaind will be used for this purpose only. Signature of individual requesting search ________________________________________________________________________ TO BE COMPLETED BY THE PUTA TIVE FATHER REGISTRY: Date Request Received (MM/DD/YY) ___________________________________________ ODJFS Staff _____________________________ Date of Search Request es Set arch Requ(MM/DD/YY) ___________________________________________ R e cord Locator ___________________________ Date Search Performed (MM/DD/YY) ___________________________________________ ODJFS Staff _____________________________ Outcome ___________________________________________________________________________________________________ Registered (Name of Father) _______________________________________ Registered Record Locator ____________________ JFS 01695 (REV. 9/2003) LCPC APPLICATION FOR SEARCH OF OHIO PUTATIVE FATHER REGISTRY PAGE 2 OF 2 American LegalNet, Inc. www.USCourtForms.com
|
|||||||
