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RVICE BY ADOPTION ASSESSOR On the day of the birth mother birth father , , I provided of the above named child with a copy of the Ohio Department of Job and Family Services Form, JFS-01676 (Rev. 6/2001). Signature of Adoption Assessor Typed or Printed Name Address City, State, Zip Code Telephone Number include area code Reset Form FRANKLIN COUNTY FORM e18.10 - CERTIFICATE OF SERVICE BY ADOPTION ASSESSOR.

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