Judgement Entry Granting Foreign Birth Record

Reset Form Print Form PROBATE COURT OF LUCAS COUNTY, OHIO JUDGE JACK R. PUFFENBERGER IN THE MATTER OF THE ADOPTION OF: _______________________________________ (Name after Adoption) Case No.: _____________________ JUDGMENT ENTRY GRANTING FOREIGN BIRTH RECORD At the request of the Petitioner(s) who have adopted a child pursuant to a Certificate of Adoption issued outside of the United States, pursuant to Ohio Revised Code Section 3107.18, it is 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. That the child's name shall be changed to: The child's birth date shall be revised to reflect a new birth date of _____________________ per recommendation of _______________________________________________. (Physician) . _______________________ Date ______________________________ Judge Jack R. Puffenberger cc: Petitioners FORM ­ ADJEFBR ­ JUDGMENT ENTRY GRANTING FOREIGN BIRTH RECORD EFF. DATE 11/2008 American LegalNet, Inc. www.FormsWorkFlow.com