Request For Foreign Birth Record {19.7}

IN THE COURT OF COMMON PLEAS OF WOOD COUNTY, OHIO PROBATE DIVISION In the Matter of: The Foreign Adoption of: * * *********** REQUEST FOR FOREIGN BIRTH RECORD R.C. 3107.18 (C) _________________________________ and _________________________________ petition(s) the Court for the following: An order to issue a foreign birth record to be issued from the Bureau of Vital Statistics, Columbus, Ohio for __________________________________ born on __________________ in the country of ___________________________. A Final or Interlocutory Order of Adoption A name change to _____________________________________ as indicated on the Vital Statistics, Certificate of Adoption form which is attached. THE FOREIGN BIRTH CERTIFICATE AND THE FOREIGN DECREE/CERTIFICATE OF ADOPTION, WHICH HAVE BEEN VERIFIED AND APPROVED BY THE IMMIGRATION AND NATURALIZATION SERVICE OF THE UNITED STATES, MUST BE ATTACHED. AND, IF NOT IN ENGLISH, ALSO ATTACH A TRANSLATION CERTIFIED AS TO ITS ACCURACY BY THE TRANSLATOR. Case No. Judge David E. Woessner Applicant's Printed Name Applicant's Signature Applicant's Printed Name Applicant's Signature Applicant's Address Telephone Number American LegalNet, Inc. www.USCourtForms.com ORDER TO ISSUE FOREIGN BIRTH RECORD At the request of the above parties who have adopted a child pursuant to a Certificate of Adoption issued outside the United States, it is hereby ORDERED: That the Department of Health issue a foreign birth record for the adopted child. A translation of said foreign birth certificate and foreign decree or certificate of adoption certified as to its accuracy by the translator is attached. The child's name is changed to _________________________________. A Final or Interlocutory Adoption Decree is issued and attached hereto. Date Journalized: ________________________ ____________________________________ David E. Woessner, Probate Judge 7/22/05 19.7 - Request for Foreign Birth Record 19.7E - Order to Issue Foreign Birth Record 2 American LegalNet, Inc. www.USCourtForms.com