Affidavit {18.3B}

ePC-A-18.3B (Rev. 12-2003) PROBATE COURT OF FRANKLIN COUNTY, OHIO ROBERT G. MONTGOMERY, JUDGE IN THE MATTER OF THE ADOPTION OF Name after adoption CASE NO. ADOPTING PARENTS AT FIRST HEARING: AFFIDAVIT The undersigned, having been duly sworn in open court, being the adopting parents of the abovenamed child, state(s) that the identity of the birth mother and father are unknown to us, or our knowledge is limited to: We acquired knowledge by way of: Further, the undersigned understand they are not required to provide the birth mother and birth father with letters, pictures, or any other means of communication against our will now or in the future and any agreements previously entered into regarding dissemination of information is not enforceable by the undersigned, the attorneys, or the birth mother or birth father. Adopting Parent Adopting Parent Sworn to before me and subscribed in my presence this day of 20 . Signature page attached Notary Public / Deputy Clerk / Magistrate FRANKLIN COUNTY FORM e18.3B - AFFIDAVIT American LegalNet, Inc. www.FormsWorkFlow.com