Consent To Placement For Adoption {Form IV}

<document>COUNTY OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .:::::::Index No.Calendar No.JUDICIAL SUBPOENAPlaintiff(s) -against-Defendant(s)IN THE COMMON PLEAS COURT OF ERIE COUNTY, OHIOPROBATE DIVISIONIN THE MATTER OF THE*CASE NO. PLACEMENT FOR ADOPTION OF**CONSENT TO PLACEMENT *FOR ADOPTION * ********************************************************************************. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .THE PEOPLE OF THE STATE OF NEW YORK TOThe undersigned, , represents that he/she is qualified to consent to the placement for adoption of the child of Name of mother/and or father born , and consents to the placement for adoption of the child as proposed in the Application for Placement filed herein by Name of mother/and or father I hereby waive notice of the hearing on the Application for Placement filed in this cause. The undersigned further represents that this court has final jurisdiction to determine whether said placement is in the best interest of said child and there have been no promises made to me/us that said Application for Placement will be approved.GREETINGS:WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Court at the the Honorable,located at County ofo'clock in the day of, on the, 20, at or adjourned date, to testify and give evidence as a witness in this action on the part of thenoon, and at any recessed in roomFatherYour failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply.Mother, one of the Justices of theDateCourt in Witness, Honorableday of, 20 County,(Attorney must sign above and type name below)Attorney(s) forOffice and P.O. AddressTelephone No.: Facsimile No.: E-Mail Address:Mobile Tel. No.:Form IVAmerican LegalNet, Inc. www.USCourtForms.com</document>