Certificate Of Service By Adoption Assessor {18.10}

ePC-A-18.10 (Rev. 11-2001) PROBATE COURT OF FRANKLIN COUNTY, OHIO ROBERT G. MONTGOMERY, JUDGE IN THE MATTER OF THE ADOPTION OF CASE NO. Name after adoption CERTIFICATE OF SERVICE BY ADOPTION ASSESSOR On the day of birth father , , I provided the birth mother of the above named child with a copy of the Ohio Department of Job and Family Services Form, JFS-01676 (Rev. 6/2001). Signature of Adoption Assessor Typed or Printed Name Address City, State, Zip Code Telephone Number [include area code] FRANKLIN COUNTY FORM e18.10 - CERTIFICATE OF SERVICE BY ADOPTION ASSESSOR American LegalNet, Inc. www.FormsWorkFlow.com