Application For Approval Of Placement Form - Court Of Defiance County, Ohio
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1PROBATE
C OURT
O F
D EFIANCE
C OUNTY,
O HIO
JEFFREY
A .
S TRAUSBAUGH,
J UDGE
PLACEMENT
O F
_ ___________________________________________________
(Name
b efore
p lacement)
CASE
N O.
_ ______________________
APPLICATION
F OR
A PPROVAL
O F
P LACEMENT
Now
comes
___________________________________,
and
represents
that
__he
is
the
(mother)
( father)
a nd
l egal
p arent
o f
_ ____________________________________
w ho
w as
b orn
o n
t he
__________
day
of
________________________
at
____________________________________.
Said
applicant
s tates
t hat
_ _he
i s
_ _____
y ears
o f
a ge
a nd
n ot
u nder
a ny
d isability.
Applicant
p roposes
t o
p lace
s aid
c hild
i n
t he
h ome
o f
_ __________________________________
and
_ _____________________________,
w ho
a re
h usband
a nd
w ife,
a nd
w hose
a ddress
i s:
________________________________________________________________________
for
t he
p urpose
o f
h aving
t hem
a dopt
s aid
c hild.
Wherefore,
your
applicant
prays
the
Court
to
set
a
day
for
hearing
on
said
proposed
placement
and
t hat
s aid
p lacement
b e
a pproved
i n
a ccordance
w ith
l aw.
___________________________________
________________________________
Witness
Applicant
________________________________________
Typed
o r
P rinted
N ame
________________________________________
Address
________________________________________
________________________________________
Phone
N umber
( include
a rea
c ode)
D.C.
F orm
6 A
–
A pplication
f or
A pproval
o f
P lacement
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