Affidavit {19.01}

IN THE COURT OF COMMON PLEAS WARREN COUNTY, OHIO PROBATE DIVISION In the Matter of the Adoption of _____________________________ (Name after Adoption) ) ) ) Case No. __________________ AFFIDAVIT STATE OF OHIO, WARREN COUNTY SS: Now comes ________________________________, and hereby swears and avers that: I/we are the petitioner(s) in an action to adopt an adult; OR I/we have established a child-stepparent relationship (attach certified copy of marriage license); OR I/we have established a child-foster parent relationship. "Foster caregiver means a person holding a valid foster home certificate issued under section 5103.03 of the Revised Code (attach copy of certificate); OR I/we have established a child-kinship caregiver (attach certified copy of custody order); OR the adult was, at the time of the adult's eighteenth birthday, in the permanent custody of or in a planned permanent living arrangement with a public children services agency or a private child placing agency (attach certified copy of custody order); OR adult is the child of the spouse of the petitioner (attach certified copy of marriage license). ____________________________ Petitioner(s) ____________________________ Petitioner(s) Sworn to before me and subscribed in my presence this _____ day of ______________, 20_____. ____________________________ Notary Public FORM 19.01 - AFFIDAVIT OF RELATIONSHIP WITH ADULT ADOPTEE American LegalNet, Inc. www.FormsWorkFlow.com