PROBATE COURT OF _______________ COUNTY, OHIO
IN THE MATTER OF THE ADOPTION OF _________________________________________
(Name after adoption)
CASE NO. ___________
CONSENT TO ADOPTION
[R.C. 3107.06, 3107.08 & 3107.081]
The undersigned _____________________________________________________________
[check one of the following seven capacities by which your consent is given]
Putative father who has registered under R.C. 3107.062
Agency having permanent custody
Minor, who is more than twelve years of age (this consent must be executed
in the presence of the Court)
hereby waives notice of the hearing on the Petition For Adoption to be filed in the court, and
consents to the adoption of ___________________________________________________
(Name before adoption)
as proposed in the petition.
The undersigned further states that this consent is voluntarily executed irrespective of
disclosure of the name or other identification of the prospective adopting parents.
Sworn to before me and signed in my presence this _______ day of _____________, 20_____
Person authorized pursuant to R.C.
Chapter 3107 to take this
FORM 18.3 - CONSENT TO ADOPTION
Amended: March 15, 2016
Discard all previous versions of this form