Consent To Adoption {18.3}

PROBATE COURT OF CUYAHOGA COUNTY, OHIO JOHN J. DONNELLY, Presiding Judge JOHN E. CORRIGAN, Judge 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 gi ven] q Mother q Father q Putative father who has registered under R.C. 3107.062 (for a minor bor n on or after January 1, 1997) q Putative father (for a minor born before January 1, 1997) q Agency having permanent custody q Minor, who is more than twelve years of age (this consent must be execu ted in the presence of the Court) q Other hereby waives notice of the hearing on the Petition for Adoption to be f iled in the court, and consents to the adoption of as proposed in the petition. (Name before Adoption) 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 , Person authorized pursuant to R.C. Chapter 3107 to take this acknowledgment Title 18.3- CONSENT TO ADOPTION 8/97 American LegalNet, Inc. www.USCourtForms.com