Free Microsoft Word - Adoption Series 18-19.1.DOC - Ohio

PROBATE COURT OF ______________________ COUNTY, OHIO
IN THE MATTER OF THE ADOPTION OF _______________________________________________
(Name after adoption)

CASE NO. _____________________

CONSENT TO ADOPTION
[R.C. 3107.06, 3107.08 & 3107.081]

The undersigned ___________________________________________________________________________ [check one of the following seven capacities by which your consent is given] Mother Father Putative father who has registered under R.C. 3107.062 (for a minor born on or after January 1, 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) Other ________________________________________________________________________

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 or other identification of the prospective adopting parents.

_______________________________________

Sworn to before me and signed in my presence this ______ day of ___________________________, 20____

__________________________________________ Person authorized pursuant to R.C. Chapter 3107 to take this acknowledgement __________________________________________ Title
18.3 - CONSENT TO ADOPTION 10/1/97