Hospital Release {118.32}

PROBATE COURT OF HAMILTON COUNTY, OHIO RALPH WINKLER, JUDGE PLACEMENT OF (Name before placement) CASE NO. HOSPITAL RELEASE TO: Name of Hospital The Court has issued an order approving the placement for adoption of a certain (male)(female) infant born on the day of and husband and wife, who have filed a Petition for Adoption with this Court. The and their attorney, Hospital Release. It is further ordered that the Hospital keep the information contained in this Hospital Release strictly confidential. Said information contained herein is sealed under Ohio law. Inquiries into the release of this information should be directed to the Hamilton County Probate Court. Hospital may release said child to , or , upon presentation of a certified copy of this , with , Ralph Winkler, Probate Judge American LegalNet, Inc. www.FormsWorkFlow.com H.C. FORM 118.32 - HOSPITAL RELEASE 02/10/03