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PROBATE COURT OF LUCAS COUNTY, OHIO JACK R. PUFFENBERGER, JUDGE IN THE MATTER OF THE ADOPTION OF: (Name after Adoption) CASE NO. ________________ PETITION OF FOREIGN ADOPTION (R.C. 3107.18) (Check applicable boxes, complete applicable blanks, strike inapplicable language, and attach supporting documentation) The Petitioner(s) is/are the adoptive parent(s) of a minor child pursuant to a foreign decree or certificate of adoption and state that: PETITIONER(S) Petitioner's Full Name: Petitioner's Full Name: Residence: Duration of Residence: Date & Place of Marriage: ADOPTED CHILD Name of Child Before Adoption: Name of Child After Adoption: Date & Place of Birth: ATTACHED IS A CERTIFIED COPY OF THE CHILD'S BIRTH CERTIFICATE, AND IF NOT IN ENGLISH, ALSO ATTACHED IS A TRANSLATION CERTIFIED AS TO ITS ACCURACY BY THE TRANSLATOR. A Foreign Decree or Certificate of Adoption in compliance with the laws of the country of ___________________________ was issued by (Name of Court): , In Case Number _______________________ on the ___ day of __________________, ______. PAGE 1 OF 2 OF FORM ADPFA PETITION OF FOREIGN ADOPTION American LegalNet, Inc. www.FormsWorkFlow.com Marital Status: CASE NO. ATTACHED IS A CERTIFIED COPY OF THE FOREIGN DECREE OR CERTIFICATE OF ADOPTION WHICH HAS BEEN VERIFIED AND APPROVED BY THE IMMIGRATION AND NATURALIZATION SERVICE OF THE UNITED STATES, AND IF NOT IN ENGLISH, ALSO ATTACHED IS A TRANSLATION CERTIFIED AS TO ITS ACCURACY BY THE TRANSLATOR. Attached is a fully completed Ohio Department of Health, Division of Vital Statistics, Certificate of Adoption Form HEA 2757. The Petitioner(s) state that giving effect to the Foreign Decree or Certificate of Adoption would not violate the public policy of the State of Ohio and respectfully pray for the following Order(s): A Final or Interlocutory Order of Adoption An Order that the child's name shall be changed to: An Order to the Department of Health to issue a foreign birth record for the adopted person under R.C. 3705.12(A)(4). Attorney for Petitioner(s) Typed or Printed name Address ____________________________________ Petitioner ____________________________________ Petitioner ____________________________________ Address ____________________________________ ____________________________________ Phone Number (include area code) Phone Number (include area code) ____________________________________ Attorney Registration Number Print Form Reset Form PAGE 2 OF 2 OF FORM ADPFA PETITION OF FOREIGN ADOPTION American LegalNet, Inc. www.FormsWorkFlow.com