CERTIFICATE OF COPIES

IN RE: Richard Barkey

The State of Ohio, Summit County, 55.

I, BILL SPICER, Judge of the Court of Common Pleas, Probate Division, within and for said

County, said Court being a Court of Record, having a Seal, do hereby certify that the foregoing is

a full and correct copy of the Adoption File, case number A 8358.

I further Certify that by the laws of the State of Ohio, I am ex-officio Clerk of said Court~

having sole custody of the Records, Archives, and Seal of said Court; that I have been duly

commissioned and qualified as Judge of said Court; and that this attestation is in due form of law.

In Testimony Whereof, I have hereunto set my hand and

affixed the seal of said Court at Akron, Ohio, this 2tfh day of

June A.D., 2011.

BILL SPICER, Judge and ex-officio Clerk of said Court

BY W. 2. Lori R. Hargrove Adoption Clerk

(NOT REQUIRED IF CHILD IS A WARD OF CERTIFIED CHILD-CARING ORGANIZATION)

CHILD'S FATHER CHILD'S MOTHER'

Age .................................................................... . P ... ge .................................................................... .

Birth p lace ··············(cit;)·························(C~~~t;)··············~··········(·St~t·~)········· Birth place ·······4······· .. ···················(C~~~t;)·························(·St~t·~) .. ········ Nationality or race.......................................................................................... Nationality or race........ . .......................................................................... .

. __ x:) Occupation and VI ages................................................. ................................ OccupatIon and wa~~ ....................................................................... ..

Marriage --····(D·;.~)··················-·(·pi;~;)··....·-··· Marriage .-.... -(D;;;~~~"'*~lI;.;';J~·····~·······~········ Present Address ................................................................................................ Present Address .......... :.: ........................................ ~.;.................. . ........ w.

. ... Religion........................................................................................................................ Religion........................................................................................................................ ...

If of school age, where would child attend S~hOOl?~ ....... ~ ..... ~~~ ........................ . ... L~.;r.::e.;,::.2 ................................................................................................................................................................................................................ ~ .......................... _ ... _

Where vvouldchild sleep ? ..... ~ .... ~ .......... ~ .............................................................. : ................... , ................................. c ....... , •••••••••••• "

r"

t I

Date of investigation .......... ~ .. ~ .. i..~~ ... 7 .. . ~~ .. ............ +-.. d .... ~ .......................................................... .. . . . (-Irwestigator)

: f

L .. .J

THE HUSBAND or Other IV[ale Petitioner.

Details of physical defect or illness. Habits: Drink, tObacco~profanit. ~ ~ ~ ~,c _ ''''0 ~ ~ , jl /,

~,,~.1 I'"JA.,..c.I ~ .. I-'~-'-~ "

THE WIFE or Other Female Petitioner.

Details of physical defect or illness. I-Iabits: Drink, tobacco, profanity.

~ ~ ry ~/ "l-<--CJ ~O'Y" ~ ~ J ...... I~. ./ r-u

Education, intelligence, mental defects, natural re-i Education, intelligence, mental defects, natural re-finement, personal appearance,. ... finement, personal appearance. t"

~,~~ ~ "!?~~/~~~~ ~/~'? ~~6i ez--£~~::I 9v~~ /~~ ~~ . I ~Me~~ / e&~"';:...(

Member of what church, distance from tendance, active part.

~~ ~~

home, at-I, Member of what church, distance tendance, active part.

~~ I~~~

from home, at-

Where employed, industrious, income, pay bills Employment outside of home, special work at home. -promptly.

~~Ih,~~. ~. 7IJ.r~---<-~ ~~6!,!

;------------------------------------------------Social life and fraternal connections. Social life and fraternal connections.

Describe the neighborhood (undesirable features).

THE HOME OF PETITIONERS

Value of home if owned ... d ...... LID.2 ....................... Rent.................................................................. Acreage. .................................................... .

How used. ......................... ~.rrI..~:.:~-::: .................................................... How much yard ........ ~f...P ... 2:~ .. :. ... .? ..... , ... : ................................................... ..

Location and value of other property ................ ~~:t:::.,..-::h,S;., ......................................................................................................................................... .

" ~~ ~ Rooms in house ........... 7. ............................................ Bath ..... ~ ...... Automobile .... ~~ ........... Special Industry ............................. .

Live stoclc .................................... : .................................................................................................................................................................................................................................. .

Prob. 615-T. Barrett Brothers, Publishers, Springfield, Ohio.

Rel)Ort 011 PrOlJOsed Adoptio11 General Code, Section 8024-1 .

~ .Probate Court ..... , ..... ~~ .......... county, Ohio.

N arne of Child ................ ~:.::' ............ ~ ........................................... _ ....... _....... ( ................................................... ) . ~ . '.z:::..a.Q /7J. L "Boy"~~Gir-l#·· To be changed tc(.Jt&~~ .. -... ::"~ .. _ ... ~ ............ e.;;) .. 4&.-~L... f Names of petitioner~~ .... d ... ~~~\1g ........... ~~~ .. :r~. "'_ Address Lt:tl:rP ............. :: ........ /,~ ........................................ _ .. kt~ .... _ .................. ~ ................. ,~~~~4-::.d

(Street and Number or R. F. D.) (City or Village) (County)

THE FA]\'IILY OF THE PETITIONERS

N ames of Members of Family at Address Stated I Race

Birthplace City or State

Occupation and Wage School and Grade

I Age N atii:J'4~lity or I -Hu-sba-~--.~-.~-........ -....... ~-.~ ....... -L.t1Q-.. C~~-F-......... -....... -.;5r.l.Jf .. fV~.£?~ .. ~.,& •. ~.~ Wife (l\~ .. !.~~.I...3.?-... ~~ .. ~ .... Q. ........ ~ -----_Childr~______ I 3~rl

1.

2.

3.

. I .

:'. ...: .... ~:~ ...... : ........ ~~.: .. ~~ ... :~ .... ~.:~.~~:: ... ~~ ..... : .... :: .. ~ ... -..: .. ~ .... J .: .. : ... :.:.I·:·.··:::.:.]I:·::.:.::~.: ... :.: ...... :::.:'.::'I"::::::.:":::.::::::':'.~:~~:~.:~.::'" :::":':":'.:.:.::~.'.:'.'.:.::~:.::.:': 6 .................................................................................................................................... , ........................ 1 ............................................................................................ .

Other Members of the Household I Age I Sex Relationship I Health, Etc .

.................................................................................... 1 ..................................................................... 1 ..................................................................................... .

........................... ~ ............................... i .................. , ................................................... 1 ................................................................................... .

················································c··:·· ......... :.=: •........... ! ····~········,J·····················I·····························:I········,,··········c:.; .. - • ..:,c~.;.;;.'",;c~ ..... ,,~ ... ~ ... ~ . • ....-~ .... - .. :.::~~ ...................................... ·······················:······ .. ··········1············ .. ····· .. 1····················· .. ··· .. ··1················· ................................................................. .

:':.':.:::.:':.':::::':::':::'::'::':':':::.':: ... :.:'·:.:::~.·.::: .... : .... ··:]·.·:·:··.:::·.:·::I: ..... :··: ....... :J::::.:.:.:.::.:::: ... :: .. :]:~ ......... :::.::.: .... ::.: .. :.: .. : .. : ........ ::.::~::.: ... ::::::.: .. :::.'.::'.::. BRIEF HISTORY OF PETITIONERS

Date of marriage.C~~ ..... Ld-!..f...?.z...Place of marriage ........ a.:/~.t.: ... ~.~!. ............ . Length of residence in county~ .... ~ ... ; .... i .. 6 .... ~ .. '7.:J~ ... h. ... ~.-::. ... Number of children by this marriage ....... ~~ ... Facts concerning those not at home ........................................................ :

Prob. 615~B 24-10-4 Barrett Brothers, Publishers, Springfield, Ohio

ANSWEl;: 'Ar~D CONSENT-ADOPTION General Code, Sec. 8025

J • '. " . " 'it' '. Probate court, ............. , ...... ~~~ .... : ............ ~ ... county,' Ohio.

:_. . In th~ Matter of the Adoption of-'

• I ' • - .. ,:-- ~ f: . ---, / ANSWER AND CONSENT

( /' J '. / . Y h_#-- .....'f.

repre~ents that ....... ~e is qualified tl consent to the legal' ~(10PtiO~.OL ... , .. :.~~~Y..:(lL-!~A..../. .... (!;~.!....,4.r .. ~ ....... . ~- d .

........................................................................... :! •...................... -..... ~ .... , age-:;·r/-,.t::!.;.!f::'::1)······:·~:;:t·~;..;.,··;(.l·~~···~······ii······ ...... , .... =~;:~l}t:;;~":;i-ii~-;;·?:······ ,',' /..l~ C' /" ,";/./ h-·····t=l ,l'?OYd l r gl~l.

to the petitioners .. --.......... ~.../:A.J~ .. Jp-t .... IJ ... #Jt-.A1:::JJ.~r~ .... and ...... \,}· .... ;\ ... L.1J .... ;t!L~1 ... ~.q ......... ; .. J/~'.M.~/'~.·~-.J..'.~~:;\ .. I. ",' i/ I': . l "/"-. ."-. . ..L+_""~ " ..~;

as provided,in Section 8025 of the ,G,. eneral Code of Ohio/by virtu~ of: ....... ;: .. ! .. -::~ .. ;~-r.!A .. -4 .......... : .... ~~~.~-.......... ~~.~ .... i:l / tl .1.. _.' .' J /1:' l/", (See pr~visions of law go';'erning constnt).lll

...... :.: ... ::!..~?'.:(.; .... ~._r. .......... l:~z..-:.(Y:~i(! ... ~ .. , .... ~~;~:.::~~ ............... ,.;,"-'",,; ..... ;~.:.~~ ... :, .. : ...... ~=i ........ ::j. ....... =~(.. .......... .. J-"-::t. ... -. \ I Z' .,< ~ /1' .' ,. I, .J . j .' . /'- . '. /1 ~'I / It·,·· " A - .. ,' ~-"- ;,( .... ~<: ........... :;~:.... .. ~;*!. .. ~... . . ...• ,~.; •.•••••• /. .• ~·:: •• s;:):·····r~·L, ~:'JL/. ..... ::' .. { .......... :.::.· .. ~~:Ul.t1 .... :4.?.: .. l.., ... ···-·:·\'-.A.~~1····:···~~-;··:~r.l-!iLf .... ~ .. .

__ ,~:_::~ ____ ;~;i __ ~.~VI __ :,~_!L::..,!l,,/.-__ J ___ =:~::.t.~ __ Al. ___ =~~~~ _____ ~:,1.:_:. ___ ~._,,_"':~:;~,,~",..~4.£.l ----:::,~--L:;-,----...:-... 4--------------------------------- ---~------------~-

(i . ........... ':w ................................................................................................................................................................................................................................................ .

. ....... he further represents that ...... he has examined the petition and does believe that the statements and

allegations therein are true; that all the provisions of the law governing adoptions have been complied

with; and that ........ he therefore consents to .the adoption ,of said child by said petitiqn'ers and to the change r) .. " .' "'"II.,' •

! ~'/-- :. j.. I''';" I ",""" J /"

:: :r::~~f:rO:ns::dc:::::O:~ -'J~~!--J---~--4~'LAd·f------- to--}---f'L~-k~Y!"-1--~c,,-~J,1-t~::'-·-L:. -">7--. I

Dated this ....... L .. L ...... day of ......... (} .. ~ .................. 192 .. 7. ..... .. :/

_. ,"\ .' ,f &. :.'1\A.4~'<'tr ... :rt~ ;1 !~, L/ ·

The State of ~o, .. (T .................... ::., .................. ~ ......... ~~··~:j~'\ ........ County, ss:

. ~ ~ )/ ~ J C,-, . .................... -'=- .... !. ..... I' .. l.( .... ~ ....... -'l::t.;!<-~I-tt.LI~rz ................................................. being duly S'VllOn1, says that the statements

contained in the foregoing aJs~er and consent are true as ....... he verily believes.

\<."------k--l2i----------------------------------------- ---------------

Prob. 6 I 5-F X Gen'l Code, Sec. 2084. 21-9-1 Barrett Brothers, Publishers, Springfie1d, Ohio .

. Probate COiJrtJ __________________ .Q"lDmlJi_t ___________________________ County) Ohio.

_______________ O_c_t_o_ber_~---20-,------:------,ll . . j). 192--'1-.

In the .liat/fl' 0/ ,ldoldion 0/ I l{ O. _______ H35B .. ____ _

.L.e.9.t.6JL .... Blak6. ~ ............................................ J PETITIO}\f FILED

ORDER FOR HEARING

rIll' I h 1 B 1. r/ S (1 ({!J ----------D ar- es----E .. ----- ar-ke-y.-----anG-----Ma-tiJ.-Ela-----Barkey-,----------------_______ _

____________ ._~--------------------------------------- ___________________________ _____ ./ll f S /)(1 II (/ (t7 uz. -7 f'I} e .. -UjJ jJeaTcd in. opel u

____ _ Le _sot e_r.. _____ B lak e _____________________________________________ . ______________ ) (l-li e -__ 2 __ :yr_B _ .. _,_ -_ July __ .5_ ,.1-9-2 :.z--------) .

_~_~1_~_ .. ________ chilcZ o!---_--unknown--.f.at.her---and--.Naomi---Blake-;---motheT:-------------------.--------) "Lo)" 01' "girl"

i () l II e 7 Z,({lll e o! ____________ Richar_d _____ Ea-r.l _____ Baroke:y: _____________ --------------------------------- _____________________ -OJ'

. 7 ., S ,. tS' .. /. rJ! CT· U 1d /. iii C (nt SU'e7' (nt( . (:Ofl.Se7Z:, z·n lUI'z,iTn!::! 0 ------ -.. __ M. ___ .()_ane s-,---Er..op.r-.i.et.o.r---.o.f---Ve-il--

Ma±er.nity--Ho~-pi-t.aJ.-}---La"_ghG-l">He_,----Pa-. -;---a-nd---G-e-orge--McC-ammont-;---a:s--·ne·xt-------

_f:rt_l?_p:_Q ___ Q_f ___ $_ai_d ___ cl1.ild ... __________________ --- ... ________________________________________________ ---------------- ________________________ _

_ _ _ _ _ _ _ _ _ _ __ _ _ _ _ __ _ _ ___ _ _ . _______________________________________________________ LX;fu'12lZlirtllrimiirl..lC

,Jnd it IJeing' 7lPC(!SSary; n7z,cle?' the 7J?'o7:ision::; of the Zau) in szuch C{~8e 7JI'orided)

. _,. .. inve~t;Lgat9r,. . that ({. clujcy'eef ((7Ui sZLztabZe perso7'7./ be appundecl os xacL..Jffi..,~1ZlXt!mn 0/ saul cln/d; tile

COl i 7't 1t e7'C U?J appoints __________________________ .H ... ____ Q ... ___ F.i_eld. ---------------------------------------- ________________________ _

"[chose duty it sludZ be to verily the aUegu/iollS of 17te pelifion; ({nd /fluke ujJ/J/'ujJl'i-

(d e in(jzr.il'l/ to d ete7'IU ina LOll etlz el' i 71 e . pro pm:iect lu~t el' j)({f'enI::; cuul theit, /; Oil l e ({f'e

saicl·1zo711 e.

Il is m'dcl'ed t71Cd ilze, said petition {)(3 for 1?ea7'zng bet07'e this [.'07..&7'/; on tile

________________________ 3lst ____ .- __________________ clay a t------.-----------OG-t obe:J?-,---------------------------"~. D. 1 D 2 ___ 7_) at

___ oNneN_NooN_o'clock ___ P._ .. _Jr. J t'/zctt Uei77.tfl not less' than len noT' 7JlOre than thirty cla.us

f7'07) {! the _________ .f_i l_ing _____ of _____ the -----pe-ti.t_i on .. --------------------------------------------------- ____________________ _ (Ufilln3" of tl:.c IJetlt:o,;.:t.." 01' ··tin1.:'! 0': ~.l'llu~l: 1.;i:lg' :~~C llC:·:t fric~ld")

_inves~igato~ _. . 7 • ,

/"iuir7 ?tif.l.:KfiJ6rrxM· S7;((7/ ({s s()on ({.s practzca.ole; and be/ore the clay /;('7'ei71 Sf'/

lo?' /u'(I!'in/d' {/;e lJcldion) 8zlZnnit to the Guzurt Cu full report in 7.U7'/hn:;:.

___ C~_~ __________ l2: ____ /~1/..-------------------------P7'ubate c/ U.ci}jl:

Prob. 615-P *23-11-3 Barrett Brothers, Publishers, Springfield, Ohio.

If the child has already at the time of the hearing on the repol't of the next friend, resided in the home of the petitioners for at least six months, and the Court is ready to make the final decree, then use the following;

Probate Court, ........ ~ ................. .s.uurrnit ............................................... County, Ohio

------Jlllle-----1.8-;1----------------~ __ ---- ____________ 1 [) 2 -.8 ~

J\f o. __________ a~~_8~ __________ _ Hearing on Report of Next Friend

DECREE (1) OF ADOPTION

J.'?~is 7ncutter canrue on this dcuy i'''urther to be hecurcl, a'ncl ___________________________________________ _

_______________________ JI.. ___ G_. ___ Fi~ld _________________________ ~ ________________________________________ ::~ _______ "&{}ho "&UC(;S heretofore

cuppointecl by the COlurt to' Cuct cu;HX~fo&~~Df sCuid chilcl) hcuvin~ 71ruacle report in

~uriting cuncl reco71ru71ruenclin~---------------~------------~----------- ---------.---.-------.------------~--- _________ . ______________ . _____ _ the pToposecl cucloption) the COlurt nOlU proG~~clecl to cu f"r..ull hecuring of the petition) c(;ncl the excan·incution of the pcurties in interest) "Lunder ocuth)' to~ether luith cull evidence) in­clludin~ sCuicl report of the~~~~~n!i~!}°ztnd incl"Ludi7~1t Culso CuS cu nrucutericul jcuct} thCut

the scuid evidence ShOlUS thcut the chilcl hcus ____ no __________________________________________________________ . _____________ . "no" or "real" or "personal"

pro p erty .. €bt:1'YOitilr,;t.;i. ~~ 4;~ -.- --- -. ----------. -- -. ---- --- -- -.-. -----. -- ----- -.-7--:- -. -- -. -- -. -.'- ---- ----- --- --------. -- -----. --- ----. ____ -_____ _ ,

~kffl'lfj) ~~n.g~~!!-~ 'f.-- ---- --- -. -------. ---- --- ---- -- .----. ----. --- -~-- --- -.----------- ---- ---- -- ----- --------- -------- ------ -- -------

The sc~icZ re.port Sh01US thcut cull thB pcurties in interest in the cCuse cure Cus foUolus:

____ Charl.e-s-----E-.-----Bar.key-----$;ud----.Ma-t-il.d~ _____ Bgr_k~.Y-.,-----t.h.~----~.P-e..t.i.tj.-Qn~-:r.§_,. ____________ _

___ .Q_. ___ M .• ___ Jg.h~.$.,.---.-Pr-QP_:r..i-e-tQR-----o.f----_Y..e..~l.. ___ J4t?:.t~_:r.p.ity-----RQ~.P1t-?):_, ______ ~.~h~~~~ ~

____ Ea .• _I- ___ ~nd. ____ Ge_o.~ge ______ M.c_G?:mmont.,------as- ___ .ne.xt _____ fr..1end _____ .o:f ______ s.9:i.d _____ chil.d~ _____ _

Ancl scuicl report Sh07,uS also thcut ____________________________ cull ?f sCuicl pca'ties in interest hcuve

hCud clne knoluled~e of the pendency of this proceeding cuncl of the cla,te set for this

7~ecu7ni71/!!. _________ . ________ . __ . _______ ----- ---... -- --- ---- -. ---- ---. -- .. --- ------.-----.- --- -.. -- ----- --- _____ ._. ____ . ___ . ___________________ .. ___________ _ (If the Oourt considers further investigation necessary, or further notice, so state)

............. _ ...... _ ..... - .. ---- --_ ................ - -- -_ ............ - .. _ ........ __ .. -_ .. -- -_ .... ---_ .......... -_ .......................... -_ .... --- ..... - .. --- ----_ ........... --;- ---_ ........... - -- -- .. _ .. -------- --- -_ .... _-_ .... --_ .. --- .. --- .. -- ---

.fincl the scuicl chilcl hcuvin~ culrecucZy residecZ for Cut Zecust six nruonths in the hon~e of

$_g.id _____ Ch~rles __ . __ E ... ___ ._B~r.ke:y:. ____ a.nd _____ M~_t_il.d~ _____ B.~~k~y.,-----------------the petitioner_f? ___ )

It is represented that said child has been in the home of the petitioners since the I _ .... /1..- ./).'

..-l 'd r\ / ~ ". ~ '.- . '~";'!':":f .•.. day Of ...... :·;;1!/ .. ~.';:(.~.\ .. A., 19 ... i .... ..:.o-' .' .. , '

\ . :, •. : .. '; . "

I~ is furth~-L' re _r'esent.e, d,that s~id:,child is"~' ward of ....... ; ........................................ . ".. \.j 7J. - ~ ~ I I' L-?j : L~,.{. ... 71. /":j' .. ~L4A7!r·A'(f(fj:" an approved child-caring organizatio~ I'ocated at ...... y.t\-t'J . ..(~ ... ~d~()t~ .. 4Af. .. :-:: ......... ::·.T?\ ..... : ... ......................................................... .

and' is now under the' e1clusive guardianship of said organizafion. .

It is' finally r~:resented that the petitioners are possessed of sufficient means

.and ability to bring up an~ educate said child properly, and therefore pray that upon

the final hearing of this casOe they./.ra: be p~~~itted ~Y order of said. Court to adopt as

. .. ,-·1 . ./, (f~J~AU theIr o,\vn clul.d sald.~ ... :.j.~.e.:..~! ... ~:.:Ld.~········~;-:-:~ .. J····~1:·,I"'-· ········:(·····{······£~·:·····/j··Z-:·······~/·'"

-{' I/~/ \ .;"/ , ' (. (JC ,~ /. and that the nan1e 9f said child be changea'.lo ... t:.\-:-:-:('-' .. ..e,.<:~ ... .f.i·a....,··j~.:~:~:v::;;.~ ..... ~ ....... ~·.e·';d..4···" .. <':,t..-1

,.~ // ' \.. I' I

f /" __ .. , /1' '---,1---"--./; I 2. ~' ·················,··~/.··U.·~4················, 0., /:)"z;!.;~e../)j~f.-:'-;; .. ~~\..!:., 192 .. : ....

...... ~:~-:..6..I .. dJ.ZZ/.2; .. 2i2:« ............ .

........... 2.1.£..?L~C&:.~ ..... w.~ .......... . THE STATE OF OHIO,

-..,.~.--"--:;-\..4.~.-'!1-~~ ........ -.-..... - County, ss. The petitioners within named being duly S'Vlorn, say that they believe that the

statements in. the foregoing petition are t:rue.

~ Witness I

... ~.:~ ... (f.d~z(/ .~{Za41k6.:~ ........................ ... ~ . (Husband)

~~£:/ ~J? h/,l" ;.-'.-" .. ' ", .... --~.- ... -.. ~-" ... :..W';:Z· ~~( C {o-.:; .. -~/~.-;:..;'- A-Ci::" - .... - ... --.:.-; . .l'i./.:..~.............................. . ... ./..//.1.0/.~i£~.) ...... ~{, :~<'r

Sworn to before me and signed in my presence this .... j ... J.: ... d.ay of..c9:t!L~t"7.;-'~~~" 192.( .

..... ~ .... 6..I ... ~~Probate Judge .

o Z

u o o

•• ----":'; ... -.-._---

'"""" " >

P.rob. 615-B 24·10·;1, Barrett Brothers, Publishers, S:pringfield, Ohio

AI'ISWER AI\fD CONSE1\JT-ADOPTION General Code, Sec. 8025

---oJ-<.-....---/'". ........ .

Probate court, ........ ::::.<~ .......... : ................. county, Ohio.

~h .. ~ .. fl1; .. ~:.~~ .. t:~ .. ~ .. :~ ...................... _J. l ANSWER AND CONSENT. . .

An?tN cOJ'es .. ·j:.~/i-! .. ~ ... ~~::o.:M4~/ .. ]~ ...... ~ ....... t~~ ......... ~~--.... : .. --..... , .. : ........................ · .... · .. ·~·7?··· .. · .. ~ .... ····.·)b""L.WhO

. regresents that ....... he is qualified to consent to the legal {f~ of... .. ./ .. "l~<.~ ...... '. ............ ·~ .. !J-f. ................ .. --................ ·· .... · .... · .. · .... · .. O ..... ·· .. ~ ...... ···7J· .. · .... · ............ ~ ....... , age· .. 7··" .. .u.li.) .. ····r;r·~ .... }d····· .. ·,(?~ :;i;; .... ·· .. .. to the petitioners ...... .::::7.-<7AA..1.L( .... 1i ... ~ ....... .............. ..... and ... J'A;rd4 .... ·jv.- .............. '(1 ........... . as provided in Section 8025 of the General Code of Ohi by virtue of: ........................................................................................... ..

(See provisions of law governing con...;ntY

....... he further represents that ...... he has examined the petition and does believe that the statements and

allegations therein are true; that all the provisions of the law governing adoptions have been complied

with; and that ........ he therefore consents to the adoption of said child by said petitioners and to the change

of the name of said child from ..... _ ..... _ ... ___ .............. _ .......................... _ ................... __ .. ___ . to .......................................................................................... ..

as prayed for in said petition,-!-/J Dated tbis ..... ~ .. O ......... day of ..... ~~ ............. :.1.92 ... 7 ... ..

. ~~~~~ ...... ~-I .. ld;...~ ... !~.1_ .. .. ~~n~~:!-.. ·--·-~r ...... - .... -.-...... -.---- .... - ............. - ..... - ... .

. ,'j ;~/' .~

The Statd~lhiO, ..... ~~ ......... " ..................... ; ...... county, ss: .

. ... /. .. ~: ... , ............ ~ ....................................................... 7 ... bemg d~ly sworn, says that the statements

contamed m the f0regomg answer and consent are true as ....... he verily heheves. ~~

. V / .... ~4 .. .f..;.1.)~, .. "~ ~ - - - - ............ : ..... :::=.=i..i.. ....... ~ ... -=.: .. :::;;;".-~~ .. ?::.. ......................... .

Sworn to before me and signed in my presence thiS ...... 2 ... t) ........ d;y Of... ....... ~ .............. 192 ... 1 ~.~~ .................. - .. .

. /E~42 c;6.....{,t; ~- .. ....................... g""... .......... :....., .... ..

- .. ',"ff"

Bond· for Placing a Dependent Child in the State of Ohio Section 1677, General Code of Ohio.

Know All Men By These Presents:

That we, the ....... Y.~.i.J .... ~t~.t.~g:D.J .. ty .... ~.9.S?P.J.t.~.1: .............................................................................................................. . Oharles E.Barkey

of ............. L.8ng.h.or.n+ .. l?a1l. ...................................................... ~as principal and ......... .M.a.t.i.lda ... Bar.ke.y ......................... .

.. ~D.4. .................................................................................................. of ...................................... . : ........... _ ..................... _ .................. _ .... - .... :- ................................ _----_ .. ---- ... -_ ..... -

as surety are held and firmly bound unto the State of Ohio in the sum of One Thousand Dollars ($1000.00), for

the payment whereof we jointly and severally bind ourselves.

Y!~::!:"r·=:, !!2~ ~~i d ... ~T..t.~ ... y..f;,J .. ~ ... Ms..1r.t.§1.:rJl~~.Y~~:·g9.§J?~.~.rJ.,.J: ........................................ __ .......... __ .... : ... __ ~ .. : ..... ~~~:~.-.-.:._.~·.-:of .'

.... __ ............ ~.?:Qg~9.~ .. !!..~ .... :r..?:.~ ....................................................... has placed ... 1.e.s.t.e.:r. .... .s.l_al~_t;l __ ....... __ ._._ ... __ ........... __ .. __ ... _ ....... ,

a dependent child, in the home of Mr. and Mrs .... __ Ql1~r.l~~;? .. E.= .. ~.?.:Kk~y ........ __ . __ .. __ ................ --............... --................ --.... .

......... __ ..................................................... at-.IQ9.Q .... N.~.R.t~D..~ ... §.t..· ..... A~}~_~~B ................................. __ ............ , Ohio, and the said

.................. Tl1.~ ... Y..e..Lt .. M9:.t.~.:r..nJ.ty. ... H.QJn:?j.t.~J ................................................................................. has agr e e d to remove

from the State of Ohio said child in case it is found to have a contagious disease, or to be deformed, feeble-minded

or vicious, or in any manner within a period of five years after the date of this contract becomes a public charge.

N ow, if the said ........ T.h.e .... y.~.j!J ... ~A~t.5?:[;.nJ.ty ... HQ.l?I~J.t§~l ........................................................................................... . will promptly receive and remove from the State of Ohio, when notified to do so by the Division of Charities of

the Department of Public Welfare, the said child, because' it is found to have a contagious disease, or to be

deformed, feeble-minded, or vicious, or in any manner within a period of five years after the date of this contra~t

becomes a public ward, then this obligation shall be void; otherwise it shall remain in full force.

Signed and sealed by us this .................... : ......................... day of. ............ :.i2.c:3D12.f.L ........................................................... .

A. D. nineteen hundred and..-.. :r.~~.~.lJJy .. §l.~.y!'m................ V ~r}'} cu~ ~ )( ~ rfl ~J~~f;

per::~:&::~~.·::::··:::·::::::::::. (Seal) (Title)_ .... :L7Z::2.:~~..z... ..... ~~.,~ ...... .

'J5;d/r'"1:1'Y~ ~t:J:.~:.....:./ ~..::-~-' ---

(Seal)

L-_------ --~

The sureties on the above bond and its amount are hereby approved by the Division of Charities of the

Department of Public Welfare, thi"--... t~J1.<?'<3.nth.o ... day Of.. .. }J.~.C::.~~!. .... -...... -.... --.. -.... _. _ ...... __ : ...... A. D. nineteen

hundred anL.tW-!2.nt.Y.:o-'HlY..<:m ............ -.. . ................... j, .. ~ ....... V .~_ ............. _ ........ . Superin tenden t

(Seal)

Describe home (cleanliness, order, comfort, sanitatiOn)~lI.~ ________ .. ~m.~. ____ ~ __ m~ . ~ /L ~ Jcr

~:~-~=~ Evidences of refinement (periodicals, books, music, Pictures) ...... C.:t.:.~ ..... ~~~;J .......•.......... ............

, r '- 1 "" .. ~.~~ .. ~ ..... ~ :~:~~ ... .). ....... C.~b"""\..:.~o! ....... ~t;::,-~:."r..!.,:::. ...... .((.. : . ::' !~" ..... ...... !.~~ ... ~.~~ :.~~~~,.:~~ : ....................................................................... .

. -...... _-----_ .. -.... -._-_ ...... .. -.. ... . . .... .. __ .. --_ .... _---_ .. . . ..... _--_ ... - ... ... _-_ ... . -..... .. . .. _-.-... --- .. -..... ----.. -.-.. -... --.- :~ ... -... -.- .. --- .... .......... ........ __ ._ --_ ......... ...... .. ..... ........ .... . __ ... .... ... ........ . _-.--.... . _- _ ........ -. -........ --. -... ---_ .... _-- ..

THE CHILD

Name.m~~~~;=mm .. TObeChangedt~~ •. ;;~/~~ Date of birth ..... · .. z · . . ....... :~::~ .... C!.# .... ,/ .. f : .. k : .............................. ;present address ... /I!E:.t;L .. U.&. ... ?4.~'-:: .... !.212 ... f:.?f!J:~::.--v.

. [ (Official) ? . -.:: / , <') / /-~ - ..

,,~~ . '~ .' >--/ .-;) ,,,,./J - -,. a Date went to home of petitioners········ · ·~~······ · :·· ··1r~ · · · ····· · ··~· i'~ ·· ....... ;: ..... ::, ...... £~:.:::~: ............................. Legitimate .............. ~~:2.. ............ .

' ~

Child's property, location ........... ~::.:~:Z:.. .. {,~k.:.:{:. :~o;-::.~,:(:: .... : ....................... ....................................................................................................................................... .

Description ................. ................ .. ........................................................................................................................................................................ ............. , .......................... : ............... .

Why do child's parents or relatives not care for it?~. . . ....... ~ ~;:;;..~<"~<"":" ~( ~¥-/.ie-d!!k:.,;,'f.::(m mmmmmm . Was child ever ward of Juvenile Court ........ ::Z:f::::.-O' .......... If so, does the Judge of the Juvenile Court consent to

the adoption ? .................................................................................................................................................................................................................................................. .

'w h'l d + d' / ?-:?£.! If d h' d f d' as c I d ever a war 0.L Ivorce court .......... !.:.......................... so, oes t e JU ge 0 ' Ivorce court consent to the

adoption? .............................................................................................................................................................................................................................................................. .

Any evidences of feeble mindedness (specify) ........ /J:-:.5.,~'t.t ... ~Y:;~~ ..... ~! .... j;f<~': . :.(:.:.. ................................................................................... .

f Any evidences of epilepsy (specify) .......................... ~~;~~:'~ ........ ~:.;~ ....... ;:f..~?.~::. ................................................................................................. .

Any evidences of tuberculosis (specify) .......... ~_-!:9..,.~-;.~~ ... ~:~:.:~ ...... ~.~I.::. ................................................................................................. . ,..

Any evidences of insanity (specify) ............ : .. , ... ~:~c .. _.~~ ........ 'y. .. '::..( · .............................................................................................. -..... -• _ ____ • ___ _ • _ _ __ _ _____ __ _ _ ___ _ __ _ _____ _ • __ _ _ __ _ •• ___ ______ _ __ __ __ _ •• ______ _ _ _ _ ___ .. . ___ __ .. .. . _ _ • • • __ • • _ •••• ••••• •• _ __ •••••• •• •• • • ••• ________ ... __ _ .... ____ •• __ • ••• • •• •• -- •• • - -- •• • •••• • • • ___ __ 0 ___ - •• •• •• •• •• _ -_ . _ _ ••••• • _- . _ __ •• _____ __ ___ •••••• __ • • _ ______ _ __ __ __ _ . _ • • ___ _ _ _ __ _ ___ • __ • ___ ••• • • _ •• • • •• __ •

, " f) '1",) *" f' ''''<''' , :(.' (J. .- -'.";1 .p,..c./,I .-Any eVidences of venereal disease (speci Y .............. -.: ............. ::-:: .. :::~ .............. · · ·· · ·· · · · · · ~:·r· ·· ·· · ···· · · · · · · ·· · · ··· ·· · · ·· ·· · · · · · · · ............................................................... .

. L:.. __ . _ _ .. __ .._ _ _ •

J.E. HARPER DI RECTOR

OEPARTMENT OF PUBLIC WELFAR[

STATE OF OHIO

DEPARTMENT OF PUBLIC WELFARE

DIVISION OF CHARITIES OAK AND NINTH STREETS

COLUMBUS

DlvrSION OF CHARITIES

BELL GREVE, SUPERINTENDENT

J. D. HOLMES, CHIEF, SUPPORT BUREAU

H. H. SHIRER, CHIEF. INSTITUTION t INSPECTION BUREAU.

s. C. GRrFFIN, SOCIAL .INVESTiGATOR.

Dec ember 12, 1927

Hon.L. D. Slusser probate Court AkroIJ, Ohio

HE: .Ado-ot ion of Lester Blake by Mr .. and lvIr·s.. Charles

tobiBarkey. My dear JlHlge Slusser: ~~:;;

We have just received. information that the Vail IvIater'XJity Hospital of Langhorn, Pennsylvania placed the a.bove mentioned child in the home of Mr. and lvtcs. Charles Barkey o6tober 1925.

customary to law this placement was made without the -proJ?eT bonel. having beeD filed. In making our irnTestigatio~1 o£ the home we .have learned that there· is a record. of inif~rJi ty .in Mrs. Barkey! s family-.

" / Dot We· T6spectfully ask yOUI' Court/to grant the ado~Qtion

until we have completed OllY invest iga tioD which we will fo Twa.rcl: to yo 1.1 •

Very truly yours, ,'''._.'',

.\ ~'_fL_~- '-4:.. . Sll"periDterl'aent. - .,

.".

BG;B'W

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J. E. HARPER DIRECTOR

STATE OF OHIO

DEPARTMENT OF PUBLIC \A/ELFARE

OIVISION OF CHARITIES OAK AND NINTH STREETS

COLUMBUS

DIVISION OF CHARITIES

BELL GREVE, SUPERINTENDENT

J. D. HOLMES, CHIEF, SUPPORT BUHEAU

H. H. SHIRER, CHIEF. INSTITUTION INSPECTION BUREAU

S. C. GRIFFIN, SOCIAL INVESTIGATOR

DEPARTMENT OF PUBLIC WELFARE

The Honorable L. D. Slusser Probate Court Akron, Ohio

lvIy dear Judge Slusser:

3anuary 27, 1928

RE: . Lest er Blake Ado~tion by Mr. and Mrs. Charles Barkey

We are sending you what information we have regarding this home.

Mrs. Barkey1 s brother,. Richard Koehn was formerly an in­mate of the lvIa.ssillol1 state HOSlli tal. He was acimi tted there January 19, 1925 and shortly after he made a recovery but another attack came and in 1926 he was transferred to the U. s. veteran's Hos~ital at Chillicothe.

We have received information which is unvarified that a maternal Aunt o:f Mrs~ Barkey was an inmate of the Massillon state Hospital and also a cousin on her side was an ~nmate of the st. Elizabeth's ~ospital in Washington.

Our investigation of the home brings out the fact that it is a suitable home for a foster child, with the excention of the consideration which might be given to the familyL back-ground of Mrs • Barkey.

On December 15, the Division of Charities acce:pted a bond to cover the placement of Lester Blake in this home.

Very truly yours~ p ~ . superin~ent.

\ BG:BW

,Att~'6:r;ttlon B(jlle GrfH~·\Te.:s

.Det)artm@!1t . Public :5;"e lfa.re~. O·olT31nhus ~ Ob.:to..·

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